Provider Demographics
NPI:1477530608
Name:LAMPLEY, CHARLES GORDON IV (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:GORDON
Last Name:LAMPLEY
Suffix:IV
Gender:M
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 W GROVER ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3825
Practice Address - Country:US
Practice Address - Phone:980-487-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39909207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
291791OtherMAMSI
5065702662OtherBCBS
SCN39909Medicaid
NC1477530608Medicaid
160021400OtherRAILROAD MEDICARE
BL3625901OtherDEA
2036110OtherAETNA US HEALTH
4541380OtherAETNA
NC8950657Medicaid
560943383GOtherCIGNA
51376OtherMEDCOST
741495OtherUHC
4541380OtherAETNA
291791OtherMAMSI
SCN39909Medicaid
NCNCE238AMedicare PIN