Provider Demographics
NPI:1083001531
Name:CHARBONNIEZ, PIERRE J (DO)
Entity Type:Individual
Prefix:DR
First Name:PIERRE
Middle Name:J
Last Name:CHARBONNIEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3412 STAUNTON AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1327
Mailing Address - Country:US
Mailing Address - Phone:304-388-6004
Mailing Address - Fax:304-388-3360
Practice Address - Street 1:3200 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-388-4172
Practice Address - Fax:304-388-4155
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3266207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine