Provider Demographics
NPI:1457451742
Name:HAUGAN, CHARUL G (MD)
Entity Type:Individual
Prefix:
First Name:CHARUL
Middle Name:G
Last Name:HAUGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 BLUE RIDGE RD STE 250
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6346
Mailing Address - Country:US
Mailing Address - Phone:919-784-3100
Mailing Address - Fax:
Practice Address - Street 1:4420 LAKE BOONE TRL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7505
Practice Address - Country:US
Practice Address - Phone:919-784-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9901541207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89129Y0Medicaid
NC129Y0OtherBLUE SHIELD
NCP00063910OtherRR MEDICARE
NCP00063910OtherRR MEDICARE
NCP00063910OtherRR MEDICARE
NCH47544Medicare UPIN