Provider Demographics
NPI:1154313575
Name:KNUPP, CHARLES L (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
Last Name:KNUPP
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:ECU PHYSICIANS
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 MOYE BLVD
Practice Address - Street 2:ECU PHYSICIANS LEO JENKINS CANCER CENTER
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4300
Practice Address - Country:US
Practice Address - Phone:252-744-1888
Practice Address - Fax:252-744-7005
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2011-11-08
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Provider Licenses
StateLicense IDTaxonomies
NC24433207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC49908OtherBCBS NC
NC8949908Medicaid
NC830002853OtherRAILROAD MEDICARE
NCC84963Medicare UPIN
NC8949908Medicaid
NC207935HMedicare PIN