Provider Demographics
NPI:1083875793
Name:LOCKLEAR, CHARLENE RESHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:RESHELL
Last Name:LOCKLEAR
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4314 LUDGATE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2461
Mailing Address - Country:US
Mailing Address - Phone:910-671-8766
Mailing Address - Fax:910-671-8768
Practice Address - Street 1:4314 LUDGATE ST
Practice Address - Street 2:SUITE B
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2461
Practice Address - Country:US
Practice Address - Phone:910-671-8766
Practice Address - Fax:910-671-8768
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2021-02-22
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Provider Licenses
StateLicense IDTaxonomies
NC2011-00810207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5917513Medicaid
NCNC0569BMedicare PIN