Provider Demographics
NPI:1891981247
Name:MONROE, CHARLES TIMOTHY (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:TIMOTHY
Last Name:MONROE
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:PO BOX 686
Mailing Address - Street 2:799 N HIGHLAND AVE
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27102-0686
Mailing Address - Country:US
Mailing Address - Phone:336-703-3099
Mailing Address - Fax:336-748-3292
Practice Address - Street 1:799 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27102-0686
Practice Address - Country:US
Practice Address - Phone:336-703-3099
Practice Address - Fax:336-748-3292
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC255142083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine