Individual
DR. CHARLES JOHN MIRABILE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 NEW HOPE RD, SUITE 104, PRINCETON, WV 24740-2143
(304) 425-8183
(304) 487-5612
Mailing address
PO BOX 857, PRINCETON, WV 24740-0857
(304) 425-8183
(304) 487-5612
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
12913
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0083600000
—
WV
Enumeration date
07/04/2006
Last updated
06/24/2008
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