Provider Demographics
NPI:1528004231
Name:WIRGES, CHARLOTTE A (MD)
Entity Type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:A
Last Name:WIRGES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1315 TIBBALS STREET
Mailing Address - Street 2:
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949
Mailing Address - Country:US
Mailing Address - Phone:308-995-6111
Mailing Address - Fax:308-995-4868
Practice Address - Street 1:1315 TIBBALS STREET
Practice Address - Street 2:
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949
Practice Address - Country:US
Practice Address - Phone:308-995-6111
Practice Address - Fax:308-995-4868
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17452207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E28069Medicare UPIN
NE0423750001Medicare NSC
272671Medicare PIN