Provider Demographics
NPI:1073809059
Name:BARRY, CHARLES DANIEL II (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DANIEL
Last Name:BARRY
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-8544
Mailing Address - Country:US
Mailing Address - Phone:304-249-8245
Mailing Address - Fax:304-301-1544
Practice Address - Street 1:524 WATSON RD
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-8544
Practice Address - Country:US
Practice Address - Phone:304-249-8245
Practice Address - Fax:304-301-1544
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV26932207L00000X
GA4770207L00000X
IAMD-42498207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology