Provider Demographics
NPI:1407836406
Name:WEST, CHARLES B JR (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:B
Last Name:WEST
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 5418
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27204-5418
Mailing Address - Country:US
Mailing Address - Phone:336-625-2333
Mailing Address - Fax:336-625-5511
Practice Address - Street 1:124 N PARK ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5440
Practice Address - Country:US
Practice Address - Phone:336-625-1007
Practice Address - Fax:336-625-0350
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38463207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
2174251BMedicare PIN
NCF34007Medicare UPIN
2174251BMedicare PIN
NC86619OtherBCBS GROUP PROVIDER #
NC44328OtherMEDCOST PROVIDER #
NC8986619Medicaid