Provider Demographics
NPI:1386646107
Name:VANDUYNE, CHARLES P (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:P
Last Name:VANDUYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4300 CITY POINT DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-8359
Mailing Address - Country:US
Mailing Address - Phone:817-284-8222
Mailing Address - Fax:817-595-5718
Practice Address - Street 1:4300 CITY POINT DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8359
Practice Address - Country:US
Practice Address - Phone:817-284-8222
Practice Address - Fax:817-595-5718
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0020207V00000X
NY135371207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB149541OtherMEDICARE UNDER GROUP 00U61E
TX113843008Medicaid
TX113843007Medicaid
TX113843006Medicaid
TX113843006Medicaid
TX113843008Medicaid