Provider Demographics
NPI:1225005515
Name:CANTERBURY, CHARLES THOMAS (HMCS - NAVY IDC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:THOMAS
Last Name:CANTERBURY
Suffix:
Gender:M
Credentials:HMCS - NAVY IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SECOND MEDICAL BATTALION, 2D MARINE LOGISTICS GROUP
Mailing Address - Street 2:PSC BOX 20129
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28542-0129
Mailing Address - Country:US
Mailing Address - Phone:910-450-7492
Mailing Address - Fax:
Practice Address - Street 1:SECOND MEDICAL BATTALION, 2D MARINE LOGISTICS GROUP
Practice Address - Street 2:PSC BOX 20129
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542-0129
Practice Address - Country:US
Practice Address - Phone:910-450-7492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-05
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman