Active NPI
Charlotte L Dillis, M.D.
- Diagnostic Radiology Physician
- Morgantown, WV
National Provider Identifier
1487613733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 16093
- Practice address
- 101 Stadium Dr
Morgantown, WV 26506-7911 - Phone
- (304) 598-4000
- Fax
- (304) 293-6963
- NPI assigned
- Mar 23, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 16093 | WV | Primary |
Addresses
Primary practice location
101 Stadium Dr
Morgantown, WV 26506-7911
Mailing address
PO Box 897
Morgantown, WV 26507-0897
Phone (304) 293-7401
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0118337000 | Medicaid | WV | |
| P00687674 | Other | DC | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1243296000000",
"number": "1487613733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 897",
"city": "MORGANTOWN",
"state": "WV",
"postal_code": "265070897",
"telephone_number": "304-293-7401",
"fax_number": "304-293-6963"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 STADIUM DR",
"city": "MORGANTOWN",
"state": "WV",
"postal_code": "265067911",
"telephone_number": "304-598-4000",
"fax_number": "304-293-6963"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DILLIS",
"first_name": "CHARLOTTE",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-23",
"last_updated": "2009-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "WV",
"license": "16093",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0118337000",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00687674",
"state": "DC"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Morgantown, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.