Provider Demographics
NPI:1427012921
Name:WRIGHT, CHARLES JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOHN
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:367 S GULPH RD
Mailing Address - Street 2:ATTN :IPM CREDENTIALING
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:484-913-7467
Mailing Address - Fax:610-878-3965
Practice Address - Street 1:3501 S SONCY RD STE 104
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6405
Practice Address - Country:US
Practice Address - Phone:806-398-3627
Practice Address - Fax:806-351-7801
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG059721207T00000X
IL036-082040207T00000X
TXN7599207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1H4413OtherPTAN
TX2012577-07Medicaid