Provider Demographics
NPI:1255307773
Name:PINKERTON, CHARLES CONRAD (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CONRAD
Last Name:PINKERTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:870 ELWYN RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5794
Mailing Address - Country:US
Mailing Address - Phone:603-431-6112
Mailing Address - Fax:603-498-9141
Practice Address - Street 1:333 BORTHWICK AVE STE 305
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7128
Practice Address - Country:US
Practice Address - Phone:603-433-6994
Practice Address - Fax:603-433-6995
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NHNH6212207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH00001026Medicaid
RE0037Medicare ID - Type Unspecified
NH00001026Medicaid