Provider Demographics
NPI:1033371711
Name:BUSH, CARRIE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:MARIE
Last Name:BUSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-3302
Mailing Address - Country:US
Mailing Address - Phone:304-388-2980
Mailing Address - Fax:304-388-2981
Practice Address - Street 1:830 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-3302
Practice Address - Country:US
Practice Address - Phone:304-388-2980
Practice Address - Fax:304-388-2981
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV26935207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology