Provider Demographics
NPI:1750513503
Name:BARTON, CHARLES H
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:H
Last Name:BARTON
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:CHARLES
Other - Middle Name:H
Other - Last Name:BARTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:BAKERTON
Mailing Address - State:WV
Mailing Address - Zip Code:25410-0159
Mailing Address - Country:US
Mailing Address - Phone:304-876-1453
Mailing Address - Fax:
Practice Address - Street 1:110 BAUGHMANS LN
Practice Address - Street 2:SUITE 201
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4059
Practice Address - Country:US
Practice Address - Phone:304-876-1453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR171823367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered