Provider Demographics
NPI:1629139712
Name:APPLETON, CHARLOTTE CHASE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:CHASE
Last Name:APPLETON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHARLOTTE
Other - Middle Name:APPLETON
Other - Last Name:SHEALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4920 NE STALLINGS DR
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1254
Mailing Address - Country:US
Mailing Address - Phone:936-569-9481
Mailing Address - Fax:
Practice Address - Street 1:4920 NE STALLINGS DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1254
Practice Address - Country:US
Practice Address - Phone:936-569-9481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12831207R00000X
TXR4806207R00000X
AK8654207R00000X
CO51708207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1629139712Medicaid
NVPENDINGMedicare PIN