Provider Demographics
NPI:1669452637
Name:HORAN, CHARLENE FRANCES (MD)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:FRANCES
Last Name:HORAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 MASON DIXON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:CORE
Mailing Address - State:WV
Mailing Address - Zip Code:26541
Mailing Address - Country:US
Mailing Address - Phone:304-879-8521
Mailing Address - Fax:304-879-4105
Practice Address - Street 1:1929 MASON DIXON HWY
Practice Address - Street 2:
Practice Address - City:MAIDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26541-8152
Practice Address - Country:US
Practice Address - Phone:304-879-5020
Practice Address - Fax:304-879-4105
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12054207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV3680D142OtherMEDICARE PTAN
WV1801631000Medicaid
WV000479346OtherBLUE CROSS
WVP01268324OtherRAILROAD
WVP01268324OtherRAILROAD
WV0505144Medicare PIN