Provider Demographics
NPI:1598766016
Name:STAAB, CHARLES HENRY III (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:HENRY
Last Name:STAAB
Suffix:III
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 1:30 MEDICAL PARK
Mailing Address - Street 2:SUITE 223
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6391
Mailing Address - Country:US
Mailing Address - Phone:304-242-3300
Mailing Address - Fax:304-242-8964
Practice Address - Street 1:30 MEDICAL PARK
Practice Address - Street 2:SUITE 223
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6391
Practice Address - Country:US
Practice Address - Phone:304-242-3300
Practice Address - Fax:304-242-8964
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11194207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0111925000Medicaid
OH0361111Medicaid
216250OtherUPMC
11194COtherHEALTH PLAN OF UPPER OH V
875707OtherMAMSI
875707OtherMAMSI