Provider Demographics
NPI:1386675270
Name:CHARLTON, GREGORY ALAN (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALAN
Last Name:CHARLTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 S TELSHOR BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4731
Mailing Address - Country:US
Mailing Address - Phone:575-522-3885
Mailing Address - Fax:575-522-3895
Practice Address - Street 1:1240 S TELSHOR BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4731
Practice Address - Country:US
Practice Address - Phone:575-522-3885
Practice Address - Fax:575-522-3895
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2011-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2001-1542084S0012X, 2084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM68700041Medicaid
AZ742785Medicaid
TX8HBN81Medicare ID - Type UnspecifiedHSZ001
TX8HBW97Medicare ID - Type UnspecifiedHSZ197
TX8HBN82Medicare ID - Type UnspecifiedHSZ006
TX8HD961Medicare ID - Type UnspecifiedHSZ002
AZ742785Medicaid
H40398Medicare UPIN
TX8HD963Medicare ID - Type UnspecifiedHSZ003