Provider Demographics
NPI:1891772737
Name:WATRAS, CHARLES STEPHEN (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:STEPHEN
Last Name:WATRAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3765 E US 64 ALT STE 7
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-6967
Mailing Address - Country:US
Mailing Address - Phone:828-835-8733
Mailing Address - Fax:828-835-8732
Practice Address - Street 1:3765 E US 64 ALT STE 7
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-6967
Practice Address - Country:US
Practice Address - Phone:828-835-8733
Practice Address - Fax:828-835-8732
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38238207Q00000X, 207Q00000X
TNMD11633207Q00000X
AL7704207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8986024Medicaid
B31153Medicare UPIN
NC213867GMedicare PIN
NC213867EMedicare ID - Type Unspecified
NC213867GMedicare PIN