Provider Demographics
NPI:1336790443
Name:WASHINGTON JR,, CHARLES DAVID
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:DAVID
Last Name:WASHINGTON JR,
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1592 GALLIA ROAD
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25520-1145
Mailing Address - Country:US
Mailing Address - Phone:304-429-6741
Mailing Address - Fax:
Practice Address - Street 1:1592 GALLIA ROAD
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:WV
Practice Address - Zip Code:25520-1145
Practice Address - Country:US
Practice Address - Phone:304-429-6741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider