Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Mark Leroy Gustafson, DO

Individual provider Emergency Medicine Physician · NPI 1851667000

Dr. Mark Leroy Gustafson, DO is an Emergency Medicine in Charleston, West Virginia. Graduated from Lincoln Memorial University Medical Department in 2012, 14 years ago. Practices with Charleston Area Medical Center Inc, a 968-clinician group and accepts Medicare assignment. Licensed in West Virginia.

Years since qualifying
14
Trained at
Lincoln Memorial University Medical Department
Licensed in
WV
In the registry since
2012
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

See every abbreviation used in this directory →

Practice location Address checks out

3110 Maccorkle Ave SE
Charleston, WV 25304-1210
Phone: (304) 388-7170
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Emergency Medicine Physician (primary) Taxonomy 207P00000X · Licence 2723 (WV)

Record details

NPI number1851667000
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedMarch 31, 2012
Last updated in NPPESDecember 16, 2016
Mailing address3100 Maccorkle Ave Se, Ste 203, Charleston, WV 25304-1228

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyEMERGENCY MEDICINE
Medical schoolLINCOLN MEMORIAL UNIVERSITY MEDICAL DEPARTMENT
Graduated 2012 (14 years in practice)
Group practice Charleston Area Medical Center Inc — 968 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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