Provider Demographics
NPI:1821078403
Name:BRANCH, CHARLES LEON JR (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:LEON
Last Name:BRANCH
Suffix:JR
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 1:690 BURTON RD
Mailing Address - Street 2:
Mailing Address - City:ADVANCE
Mailing Address - State:NC
Mailing Address - Zip Code:27006-7506
Mailing Address - Country:US
Mailing Address - Phone:336-978-8878
Mailing Address - Fax:
Practice Address - Street 1:690 BURTON RD
Practice Address - Street 2:
Practice Address - City:ADVANCE
Practice Address - State:NC
Practice Address - Zip Code:27006-7506
Practice Address - Country:US
Practice Address - Phone:336-978-8878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27027207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
21297OtherMEDCOST
2801OtherPARTNERS
NC8917801Medicaid
140007841OtherRR MEDICARE
17801OtherBCBS
SCQ27027Medicaid
VA6134700Medicaid
WV1840964000Medicaid
4607330OtherAETNA
NC2049700AMedicare PIN
WV1840964000Medicaid