Provider Demographics
NPI:1508253147
Name:CHADWELL, MARTIN L (DO)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:L
Last Name:CHADWELL
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 1:3200 MACCORKLE AVE SE
Mailing Address - Street 2:CAMC FAMILY MEDICINE CENTER
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1227
Mailing Address - Country:US
Mailing Address - Phone:304-768-3941
Mailing Address - Fax:304-766-4391
Practice Address - Street 1:3200 MACCORKLE AVE SE
Practice Address - Street 2:CAMC FAMILY MEDICINE CENTER
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-768-3941
Practice Address - Fax:304-766-4391
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV390200000X
WV3190207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program