Provider Demographics
NPI:1518188515
Name:SALEM GYNECOLOGY PLLC
Entity Type:Organization
Organization Name:SALEM GYNECOLOGY PLLC
Other - Org Name:CHARLES B. EVANS, M. D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:B
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-794-1444
Mailing Address - Street 1:2830 MAPLEWOOD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4100
Mailing Address - Country:US
Mailing Address - Phone:336-794-1444
Mailing Address - Fax:336-794-1477
Practice Address - Street 1:2830 MAPLEWOOD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4100
Practice Address - Country:US
Practice Address - Phone:336-794-1444
Practice Address - Fax:336-794-1477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32358207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC83680Medicare UPIN