Individual
CHARLENE FRANCES HORAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1929 MASON DIXON HWY, MAIDSVILLE, WV 26541-8152
(304) 879-5020
(304) 879-4105
Mailing address
1929 MASON DIXON HIGHWAY, CORE, WV 26541
(304) 879-8521
(304) 879-4105
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
12054
WV
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
12054
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000479346
BLUE CROSS
WV
05
—
1801631000
—
WV
01
—
P01268324
RAILROAD
WV
01
—
WV3680D142
MEDICARE PTAN
WV
Enumeration date
01/18/2006
Last updated
04/02/2020
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