Provider Demographics
NPI:1568695047
Name:POAGE, CHAD HARRISON (DO)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:HARRISON
Last Name:POAGE
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 1:200 ORTHOPEDIC WAY
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2633
Mailing Address - Country:US
Mailing Address - Phone:304-599-0720
Mailing Address - Fax:304-599-3962
Practice Address - Street 1:47 HIGHLAND RIDGE RD
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9263
Practice Address - Country:US
Practice Address - Phone:304-661-3167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHFS1435189207X00000X
WV3015207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery