Provider Demographics
NPI:1033308564
Name:MUNYON, CHARLES NELSON (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:NELSON
Last Name:MUNYON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-7200
Mailing Address - Fax:215-707-3831
Practice Address - Street 1:330 BILLINGSLEY RD STE 202
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-5020
Practice Address - Country:US
Practice Address - Phone:704-316-3070
Practice Address - Fax:704-316-3071
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.122041207T00000X
PAMD451261207T00000X
NC2019-01218207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0089521Medicaid
OH35.122041OtherLICENSE
OH0089521Medicaid