Provider Demographics
NPI:1205916962
Name:HILL, CHARLES EDWARD (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDWARD
Last Name:HILL
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 1:1815 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-4054
Mailing Address - Country:US
Mailing Address - Phone:302-652-4705
Mailing Address - Fax:302-652-2917
Practice Address - Street 1:1815 W 13TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-4054
Practice Address - Country:US
Practice Address - Phone:302-652-4705
Practice Address - Fax:302-652-2917
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10003620207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0482785000OtherAMERA HEALTH
Z6993OtherCOVENTRY
DE00327501Medicaid
4212430OtherAETNA
061657449OtherIND ID #
C48714Medicare UPIN
DE00327501Medicaid