Provider Demographics
NPI:1376506360
Name:PAGET, CHARLES J III (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:PAGET
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5715
Mailing Address - Fax:540-983-8212
Practice Address - Street 1:3 RIVERSIDE CIRCLE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4955
Practice Address - Country:US
Practice Address - Phone:540-224-5170
Practice Address - Fax:540-983-8212
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2022-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101-232566208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1376506360Medicaid
VA013039C19Medicare PIN
VAG30665Medicare UPIN
013039C19Medicare PIN