Provider Demographics
NPI:1952315962
Name:RICHARDS, CHARLES PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:PATRICK
Last Name:RICHARDS
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 1:180 KIMEL PARK DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6976
Mailing Address - Country:US
Mailing Address - Phone:336-397-9700
Mailing Address - Fax:336-397-9701
Practice Address - Street 1:180 KIMEL PARK DR
Practice Address - Street 2:SUITE 110
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6976
Practice Address - Country:US
Practice Address - Phone:336-397-9700
Practice Address - Fax:336-397-9701
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9801464207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891173PMedicaid
NC2231793CMedicare PIN
NC891173PMedicaid