Provider Demographics
NPI:1346268745
Name:DUNHAM, CHARLES K (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:K
Last Name:DUNHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:KENDRICK
Other - Last Name:DUNHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3000 BETHESDA PL STE 104
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3323
Mailing Address - Country:US
Mailing Address - Phone:336-293-4107
Mailing Address - Fax:949-577-4324
Practice Address - Street 1:3000 BETHESDA PL STE 104
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3323
Practice Address - Country:US
Practice Address - Phone:336-293-4107
Practice Address - Fax:949-577-4324
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01758207R00000X, 208M00000X
NC2005017582084P0800X
VA01012770932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910376Medicaid