Provider Demographics
NPI:1396716668
Name:MAINE, CHARLES P SR (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:P
Last Name:MAINE
Suffix:SR
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 1:340 ANDERSON HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-1100
Mailing Address - Country:US
Mailing Address - Phone:276-679-5880
Mailing Address - Fax:276-679-9156
Practice Address - Street 1:340 ANDERSON HOLLOW RD
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1100
Practice Address - Country:US
Practice Address - Phone:276-679-5880
Practice Address - Fax:276-679-9156
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031324207R00000X, 207RG0300X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B07882Medicare UPIN
VA014933W82Medicare PIN