Provider Demographics
NPI:1780343566
Name:CALEY, CHARLES MICHAEL (SOIDC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:MICHAEL
Last Name:CALEY
Suffix:
Gender:M
Credentials:SOIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1ST MAR RDR BN MRR MARFORSOC
Mailing Address - Street 2:PCS BOX 20184
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28542
Mailing Address - Country:US
Mailing Address - Phone:910-440-3944
Mailing Address - Fax:
Practice Address - Street 1:1ST MAR RDR BN MRR MARFORSOC
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542
Practice Address - Country:US
Practice Address - Phone:910-440-3944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman