Provider Demographics
NPI:1528536133
Name:LANDRUM, CHARITY (PA)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:
Last Name:LANDRUM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SEARLE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-3035
Mailing Address - Country:US
Mailing Address - Phone:919-681-6006
Mailing Address - Fax:919-684-0745
Practice Address - Street 1:2301 ERWIN RD 9TH FLOOR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-4608
Practice Address - Country:US
Practice Address - Phone:919-681-9341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009606363A00000X
NC0010-14124363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant