Provider Demographics
NPI:1538143276
Name:HOCHBERG, CHARLES J (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:HOCHBERG
Suffix:
Gender:M
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:PO BOX 780
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-0780
Mailing Address - Country:US
Mailing Address - Phone:304-285-7101
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506
Practice Address - Country:US
Practice Address - Phone:304-293-5631
Practice Address - Fax:304-293-2131
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19312207V00000X
WV22953207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORCD8723OtherRR MEDICARE GROUP NUMBER
OR084850Medicaid
OR160035583OtherRR MEDICARE PTAN NUMBER
WV3810010461Medicaid
OR930635514OtherGROUP TAX ID
ORR0000WFBTVOtherGROUP PIN NUMBER
OR1407812365OtherNBMC NPI NUMBER-GROUP
ORD53683Medicare UPIN
ORCD8723OtherRR MEDICARE GROUP NUMBER
ORR111967Medicare PIN
OR084850Medicaid
WV6036441Medicare PIN