Provider Demographics
NPI:1720108582
Name:CHARLES E PORTERFIELD DO
Entity type:Organization
Organization Name:CHARLES E PORTERFIELD DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:PORTERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-255-5710
Mailing Address - Street 1:PO BOX 1307
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25802-1307
Mailing Address - Country:US
Mailing Address - Phone:304-255-5710
Mailing Address - Fax:304-255-5702
Practice Address - Street 1:3771 ROBERT C BYRD DRIVE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801
Practice Address - Country:US
Practice Address - Phone:304-255-5710
Practice Address - Fax:304-255-5702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1084207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0070983001Medicaid
D01256325OtherFEDERAL
P00171545OtherRR MEDICARE
155429OtherUMWA FUNDS
WV4245814OtherAETNA
B39891Medicare UPIN
WVPR0596463Medicare ID - Type Unspecified