Provider Demographics
NPI:1891754727
Name:MCDONELL, CHARLES FRANKLIN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:FRANKLIN
Last Name:MCDONELL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:210 13TH AVENUE PL NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-2532
Mailing Address - Country:US
Mailing Address - Phone:828-322-3017
Mailing Address - Fax:828-322-1087
Practice Address - Street 1:210 13TH AVENUE PL NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-2532
Practice Address - Country:US
Practice Address - Phone:828-322-3017
Practice Address - Fax:828-322-1087
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2011-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC19178207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8956265Medicaid
NC208681Medicare ID - Type Unspecified
NCC89322Medicare UPIN