Provider Demographics
NPI:1750349130
Name:TAFT, CHARLES VAN (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:VAN
Last Name:TAFT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 25626
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27114-5626
Mailing Address - Country:US
Mailing Address - Phone:336-768-1270
Mailing Address - Fax:336-765-6375
Practice Address - Street 1:170 KIMEL PARK DR
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6946
Practice Address - Country:US
Practice Address - Phone:336-768-1270
Practice Address - Fax:336-765-6375
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC16025207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-81407Medicaid
NC210826AMedicare ID - Type Unspecified
NCC86676Medicare UPIN