Provider Demographics
NPI:1043239700
Name:NEAL, CHARLES ROGERS (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ROGERS
Last Name:NEAL
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 4574
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28406-1574
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1988 S 16TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6647
Practice Address - Country:US
Practice Address - Phone:910-251-1839
Practice Address - Fax:910-251-8286
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC357132085R0001X, 174400000X, 2085R0001X
GA292232085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
61933OtherBCBS
NC8961933Medicaid
1628858OtherUNITED HEALTHCARE
920002730OtherRAILROAD MEDICARE
92234OtherMEDCOST
61933OtherBCBS
F34015Medicare UPIN