Provider Demographics
NPI:1669455374
Name:WILLSON, CHARLES F (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:F
Last Name:WILLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:252-744-3253
Mailing Address - Fax:252-744-3194
Practice Address - Street 1:600 MOYE BLVD
Practice Address - Street 2:ECU PHYSICIANS PEDIATRICS
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4300
Practice Address - Country:US
Practice Address - Phone:252-744-2335
Practice Address - Fax:252-744-3811
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2011-12-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0020639208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8988170Medicaid
NC88170OtherBCBS NC
NC370011557OtherRAILROAD MEDICARE
NC2257104Medicare PIN
NCF17415Medicare UPIN