Provider Demographics
NPI:1528069614
Name:BESS, CHARLES D (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:D
Last Name:BESS
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:PO BOX 944
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-0944
Mailing Address - Country:US
Mailing Address - Phone:304-788-6462
Mailing Address - Fax:304-788-6555
Practice Address - Street 1:514 NEW CREEK HWY
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-9526
Practice Address - Country:US
Practice Address - Phone:304-788-6422
Practice Address - Fax:304-788-6555
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2022-04-07
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-11
Provider Licenses
StateLicense IDTaxonomies
WV17588207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0053885000Medicaid
WV0053885000Medicaid