Provider Demographics
NPI:1699772665
Name:WOOLUMS, CHARLES STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:STEPHEN
Last Name:WOOLUMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-356-8681
Mailing Address - Fax:740-353-7900
Practice Address - Street 1:1735 27TH ST STE 308
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2679
Practice Address - Country:US
Practice Address - Phone:740-356-4876
Practice Address - Fax:740-356-6703
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY34122208800000X
WV25534208800000X
OH35.133749208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810026619Medicaid
KY64049018Medicaid
OH0091070Medicaid
KY00582001Medicare PIN
KY3315708Medicare PIN
KY0992202Medicare PIN