Provider Demographics
NPI:1770183303
Name:STITH, CHARLES ESHEL III (NP)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ESHEL
Last Name:STITH
Suffix:III
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MANHATTAN SQ
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5843
Mailing Address - Country:US
Mailing Address - Phone:757-668-2200
Mailing Address - Fax:
Practice Address - Street 1:23 MANHATTAN SQ
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5843
Practice Address - Country:US
Practice Address - Phone:757-668-2200
Practice Address - Fax:757-668-2222
Is Sole Proprietor?:No
Enumeration Date:2020-11-01
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001267153208000000X
VA0024181317363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics