Provider Demographics
NPI:1225048507
Name:PEPRAH, CHARLES OKERYE
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:OKERYE
Last Name:PEPRAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:P
Other - Last Name:OKYERE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3100 SPRING FOREST RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-2880
Mailing Address - Country:US
Mailing Address - Phone:919-873-9533
Mailing Address - Fax:540-741-7615
Practice Address - Street 1:3100 SPRING FOREST RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-2880
Practice Address - Country:US
Practice Address - Phone:919-873-9533
Practice Address - Fax:540-741-7615
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164694367500000X
DCRN66454367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010307899Medicaid
MD000827300Medicaid
DC009460U31Medicare ID - Type UnspecifiedTRAILBLAZER MEDICARE
MD000827300Medicaid