Provider Demographics
NPI:1245265206
Name:CARAWAY, DAVID LEE (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:CARAWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3466
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25334-3466
Mailing Address - Country:US
Mailing Address - Phone:304-720-8816
Mailing Address - Fax:904-494-6467
Practice Address - Street 1:100 PEYTON WAY
Practice Address - Street 2:STE 200
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-8767
Practice Address - Country:US
Practice Address - Phone:304-720-8816
Practice Address - Fax:904-494-6467
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18714207L00000X, 207LP2900X, 208VP0014X, 207LP2900X
VA0101054348207L00000X, 207LP2900X, 208VP0014X, 208VP0014X
OH86568208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0207026000Medicaid
WV270052997OtherTRICARE
WVG40036Medicare UPIN
OH2037969Medicaid
WV27005299700OtherWORKERS COMP
WV0061620000Medicaid
WV4176983Medicare PIN
WVDA0096OtherRR MEDICARE
WV9333201Medicare PIN
WVP00461237OtherRR MEDICARE
WV27005299700OtherWORKERS COMP
WV0061620000Medicaid
WVDE2690OtherRR MEDICARE
OH9359502Medicare PIN
WV9359501Medicare PIN
WV4176983Medicare PIN
WV0237476OtherWASHINGTON STATE COMPENSATION
WV5831151OtherAETNA
WV3810004173Medicaid
KY64942162Medicaid
OH4176982Medicare PIN
WV001813028OtherMSBCBS
WVDA0096OtherRR MEDICARE
WV3000252OtherBRICKSTREET
KY65944555Medicaid
WV4176982Medicare PIN
WV9333201Medicare PIN
WVP00461237OtherRR MEDICARE
WV4176981Medicare PIN