Provider Demographics
NPI:1841231933
Name:GABE, CHARLES E (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:GABE
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 1:210 NEW HOPE RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2136
Mailing Address - Country:US
Mailing Address - Phone:304-425-1960
Mailing Address - Fax:304-487-3514
Practice Address - Street 1:210 NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2136
Practice Address - Country:US
Practice Address - Phone:304-425-1960
Practice Address - Fax:304-487-3514
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12312085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0118612000Medicaid
WV4231158OtherAETNA
WV0691342Medicare PIN
WV0691341Medicare ID - Type UnspecifiedMEDICARE INDIV NUMBER
WV0118612000Medicaid
WV360002638Medicare PIN
VA920006735Medicare PIN
WV920004332Medicare PIN
WV0691343Medicare PIN
C28818Medicare UPIN