Provider Demographics
NPI:1164481727
Name:FORD, CHARLES W JR (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:W
Last Name:FORD
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:870 STATE FARM RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4861
Mailing Address - Country:US
Mailing Address - Phone:828-264-4545
Mailing Address - Fax:282-264-4544
Practice Address - Street 1:870 STATE FARM RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4861
Practice Address - Country:US
Practice Address - Phone:828-264-4545
Practice Address - Fax:282-264-4544
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2014-03-12
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Provider Licenses
StateLicense IDTaxonomies
NC94-00056207Y00000X, 207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8932979Medicaid
2325244Medicare ID - Type Unspecified
NC8932979Medicaid