Provider Demographics
NPI:1013982388
Name:CHARLES, MICHAEL GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GEORGE
Last Name:CHARLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:G
Other - Last Name:CHARLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3745 HOLLAND RD STE 200
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-2866
Mailing Address - Country:US
Mailing Address - Phone:757-395-1700
Mailing Address - Fax:757-507-9004
Practice Address - Street 1:3745 HOLLAND RD STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-2866
Practice Address - Country:US
Practice Address - Phone:757-395-1700
Practice Address - Fax:757-507-9004
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005610931Medicaid