Charles John Mirabile, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

12913 Issued in WV

Practice address

100 New Hope Rd
Suite 104
Princeton, WV 24740-2143

Phone

(304) 425-8183

Fax

(304) 487-5612

NPI assigned

Jul 4, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214265600000",
    "number": "1912937764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 857",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "247400857",
            "telephone_number": "304-425-8183",
            "fax_number": "304-487-5612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NEW HOPE RD",
            "address_2": "SUITE 104",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "247402143",
            "telephone_number": "304-425-8183",
            "fax_number": "304-487-5612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRABILE",
        "first_name": "CHARLES",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2008-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WV",
            "license": "12913",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0083600000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Tara Mitchell, D.O.
• Tracy Jean Mitchell

• Internal Medicine Physician in Princeton, WV
• Providers in Princeton, WV by specialty
• Internal Medicine Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.