Provider Demographics
NPI:1578533741
Name:WILE, CHARLES HENRY (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:HENRY
Last Name:WILE
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 1:1021 PINNACLE POINT DR., SUITE 200
Mailing Address - Street 2:MONCRIEF MEDICAL HOME US ARMY
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5740
Mailing Address - Country:US
Mailing Address - Phone:803-562-2129
Mailing Address - Fax:803-419-3758
Practice Address - Street 1:1021 PINNACLE POINT DR., SUITE 200
Practice Address - Street 2:MONCRIEF MEDICAL HOME US ARMY
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-5740
Practice Address - Country:US
Practice Address - Phone:803-562-2129
Practice Address - Fax:803-419-3758
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14692207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC146926Medicaid
SC146926Medicaid
SCC03513Medicare UPIN