Provider Demographics
NPI:1306804299
Name:HONAKER, CHARLES R (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:HONAKER
Suffix:
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 1:801 GARFIELD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-5312
Mailing Address - Country:US
Mailing Address - Phone:304-424-2170
Mailing Address - Fax:304-424-2171
Practice Address - Street 1:801 GARFIELD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5312
Practice Address - Country:US
Practice Address - Phone:304-424-2170
Practice Address - Fax:304-424-2171
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV10458207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0082926000Medicaid
OH0422153Medicaid
WV406133288Medicare ID - Type UnspecifiedRAILROAD MEDICARE
OH0422153Medicaid
A72044Medicare UPIN
WV0082926000Medicaid