Provider Demographics
NPI:1558399436
Name:KING, CHARLES EDMOND JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDMOND
Last Name:KING
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:621 RIDGELY AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1081
Mailing Address - Country:US
Mailing Address - Phone:410-224-4887
Mailing Address - Fax:410-224-1428
Practice Address - Street 1:621 RIDGELY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1081
Practice Address - Country:US
Practice Address - Phone:410-224-4887
Practice Address - Fax:410-224-1428
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2015-02-19
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Provider Licenses
StateLicense IDTaxonomies
MDD0041618207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD34551800Medicaid
MD34551800Medicaid
MDD65467Medicare UPIN