Charla Lynn Anderson, MD
Individual provider Active NPI Family Medicine Physician · Wheeling, WV
NPI 1699794552 · NPPES record last updated Oct 15, 2015
Key facts
- NPI
- 1699794552
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 18847WV (WV)
- Practice address
- 2115 Chapline St Ste 105
Wheeling, WV 26003-3859 - Phone
- (304) 234-3410
- Fax
- (304) 234-8605
- NPI assigned
- Jul 19, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070427000269 | WV | Practitioner - Family Practice | 6507962107 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35071519 | OH | MD | Family Medicine Physician |
| 18847WV | WV | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 18847WV | WV | Yes |
| Family Medicine Physician | 207Q00000X | 35071519 | OH |
Addresses
Primary practice location
2115 Chapline St Ste 105
Wheeling, WV 26003-3859
Mailing address
2000 Eoff St
Wheeling, WV 26003-3823
Phone (304) 234-8663
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2044577 | Medicaid | OH | |
| 0048008000 | Medicaid | WV |
Other providers in Wheeling, WV
- Makenzie Rose Amend
- Jane Ann Amons
- Amsol Anesthetists of Ohio Valley, LLC
- Amsol Physicians of Ohio Valley, PLLC
- Brittani Anderson
- Donita Anderson
- Lydia Andlinger
- Derek Hugh Andreini
- Hugo Joseph Andreini III
- Trey Aaron Ankrom
All providers in Wheeling, WV · Family Medicine Physician in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 15, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.