Provider Demographics
NPI:1710918958
Name:BALTIMORE, CHARLES LITTLEBURG JR (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:LITTLEBURG
Last Name:BALTIMORE
Suffix:JR
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 1:639 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3526
Mailing Address - Country:US
Mailing Address - Phone:252-946-2171
Mailing Address - Fax:252-946-5986
Practice Address - Street 1:639 W 15TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3526
Practice Address - Country:US
Practice Address - Phone:252-946-2171
Practice Address - Fax:252-946-5986
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18081207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12914OtherBLUE CROSS BLUE SHIELD NC
NC8912914Medicaid
NC12914OtherBLUE CROSS BLUE SHIELD NC
NCC82692Medicare UPIN