Provider Demographics
NPI:1700859790
Name:NIEMEYER, CHARLES J (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:J
Last Name:NIEMEYER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:620 SUMMIT CROSSING PLACE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2189
Mailing Address - Country:US
Mailing Address - Phone:704-865-0077
Mailing Address - Fax:704-867-6401
Practice Address - Street 1:620 SUMMIT CROSSING PLACE
Practice Address - Street 2:SUITE 108
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2189
Practice Address - Country:US
Practice Address - Phone:704-865-0077
Practice Address - Fax:704-867-6401
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2010-08-31
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Provider Licenses
StateLicense IDTaxonomies
NC15139207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8962672Medicaid
NC8962672Medicaid
NC209210AMedicare PIN