Provider Demographics
NPI:1326154824
Name:HUMPHRIES, CHARLES THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:THOMAS
Last Name:HUMPHRIES
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Gender:M
Credentials:MD
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Mailing Address - Street 1:8045 PROVIDENCE RD
Mailing Address - Street 2:STE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-8915
Mailing Address - Country:US
Mailing Address - Phone:704-341-9600
Mailing Address - Fax:704-341-9996
Practice Address - Street 1:8045 PROVIDENCE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8745
Practice Address - Country:US
Practice Address - Phone:704-341-9600
Practice Address - Fax:704-341-9996
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2024-04-10
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Provider Licenses
StateLicense IDTaxonomies
NC31034207KA0200X, 207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8944546Medicaid
NC8944546Medicaid
NCC86879Medicare UPIN