Provider Demographics
NPI:1154308286
Name:HEISKELL, CHARLES ANDREW (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ANDREW
Last Name:HEISKELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:600 SUNCREST TOWNE CENTRE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1872
Mailing Address - Country:US
Mailing Address - Phone:304-598-2200
Mailing Address - Fax:304-599-2674
Practice Address - Street 1:600 SUNCREST TOWNE CENTRE
Practice Address - Street 2:SUITE 310
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1872
Practice Address - Country:US
Practice Address - Phone:304-598-2200
Practice Address - Fax:304-599-2674
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2015-01-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV10455208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0127483000Medicaid
WV0127483000Medicaid
WV0127483000Medicaid