Provider Demographics
NPI:1841364551
Name:BUZZANELL, CHARLES A (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:BUZZANELL
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:PO BOX 2449
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28802-2449
Mailing Address - Country:US
Mailing Address - Phone:828-350-9310
Mailing Address - Fax:828-350-9311
Practice Address - Street 1:172 ASHELAND AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4005
Practice Address - Country:US
Practice Address - Phone:828-350-9310
Practice Address - Fax:828-350-9311
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0098-00481174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900458Medicaid
NC2255358 BMedicare ID - Type Unspecified
NC5900458Medicaid