Provider Demographics
NPI:1063469856
Name:KUZMA, CHARLES SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:SAMUEL
Last Name:KUZMA
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 1:205 PAGE ROAD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8798
Mailing Address - Country:US
Mailing Address - Phone:910-295-5511
Mailing Address - Fax:
Practice Address - Street 1:220 PAGE RD
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8748
Practice Address - Country:US
Practice Address - Phone:910-715-3500
Practice Address - Fax:910-715-3501
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG87657207RH0003X
NC2009-00759207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN0075KOtherSC MEDICAID PROVIDER#
153ATOtherBC/BS NC PROVIDER#
FH2967790OtherFIRSTCAROLINACARE PROVIDER#
SCN0075KOtherSC MEDICAID PROVIDER#