Provider Demographics
NPI:1427042779
Name:HOIDAL, CHARLES R (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:HOIDAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:615 S HUGHES BLVD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-4785
Mailing Address - Country:US
Mailing Address - Phone:252-338-3111
Mailing Address - Fax:252-333-3774
Practice Address - Street 1:615 S HUGHES BLVD
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4785
Practice Address - Country:US
Practice Address - Phone:252-338-3111
Practice Address - Fax:252-333-3774
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC39952207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8942947Medicaid
NC2156422EMedicare ID - Type Unspecified
NC8942947Medicaid