Provider Demographics
NPI:1871513010
Name:TRENTHAM, CHARLES RAY (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:RAY
Last Name:TRENTHAM
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 1:72 E MCNAB RD PMB 60
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-9238
Mailing Address - Country:US
Mailing Address - Phone:954-545-0337
Mailing Address - Fax:954-545-3497
Practice Address - Street 1:120 RIVERVIEW STREET
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28744
Practice Address - Country:US
Practice Address - Phone:828-524-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC132GAOtherBLUE CROSS
NCP00276285OtherRAILROAD MEDICARE
NC891374JMedicaid
NCP00276285OtherRAILROAD MEDICARE