Provider Demographics
NPI:1457315921
Name:ESHAM, CHARLES A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:ESHAM
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 1:2401 GREENLEAF DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-2413
Mailing Address - Country:US
Mailing Address - Phone:302-475-6600
Mailing Address - Fax:302-475-6614
Practice Address - Street 1:2401 GREENLEAF DR
Practice Address - Street 2:SUITE A
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-2413
Practice Address - Country:US
Practice Address - Phone:302-475-6600
Practice Address - Fax:302-475-6614
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0003508173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000613902Medicaid
DE081738OtherMEDICARE GROUP
DE0000384501Medicaid
DEE87145Medicare UPIN