Provider Demographics
NPI:1154453686
Name:CHONG, CHARLES FERNANDEZ (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:FERNANDEZ
Last Name:CHONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:936 SHARPE HOSPITAL RD
Mailing Address - Street 2:WILLIAM SHARPE JR. HOSPITAL
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-8550
Mailing Address - Country:US
Mailing Address - Phone:304-269-1210
Mailing Address - Fax:304-269-0502
Practice Address - Street 1:936 SHARPE HOSPITAL RD
Practice Address - Street 2:WILLIAM SHARPE JR. HOSPITAL
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-8550
Practice Address - Country:US
Practice Address - Phone:304-269-1210
Practice Address - Fax:304-269-0502
Is Sole Proprietor?:No
Enumeration Date:2007-03-10
Last Update Date:2012-04-23
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Provider Licenses
StateLicense IDTaxonomies
WV11547208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0054223000Medicaid
WVWV0497AOtherMEDICARE PTAN
WV0054223000Medicaid