Provider Demographics
NPI:1548818040
Name:LACOSTE, CHARLENE MARIE (PA)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:MARIE
Last Name:LACOSTE
Suffix:
Gender:
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:2247 STATE ROUTE 18
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-9761
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-1200
Practice Address - Country:US
Practice Address - Phone:855-988-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant