Provider Demographics
NPI:1821077249
Name:AMORY, CHARLES V (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:V
Last Name:AMORY
Suffix:
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 1:6713 WILLCHER CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-1765
Mailing Address - Country:US
Mailing Address - Phone:540-548-0702
Mailing Address - Fax:
Practice Address - Street 1:12006 KILARNEY DRIVE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6101
Practice Address - Country:US
Practice Address - Phone:540-548-4510
Practice Address - Fax:540-548-8803
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101228664208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H03059Medicare UPIN