Provider Demographics
NPI:1558347484
Name:PIERCE, CHARLES G (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:G
Last Name:PIERCE
Suffix:
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 1:201 COLONY AVE S
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-3207
Mailing Address - Country:US
Mailing Address - Phone:252-332-5041
Mailing Address - Fax:252-332-6115
Practice Address - Street 1:201 COLONY AVE S
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3207
Practice Address - Country:US
Practice Address - Phone:252-332-5041
Practice Address - Fax:252-332-6115
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22162208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8967727Medicaid
NCC81514Medicare UPIN