MEDICARE: CHARLES BETHEA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101-035274	VA

General Provider Information

NPI Number	:	1407824923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES BETHEA MD

Provider Business Mailing Address
First Line	:	100 VICAR PL
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24540-1240
Country	:	US
Telephone Number	:	434-836-2100
Fax Number	:	434-836-0021

Provider Business Practice Location Address
First Line	:	100 VICAR PL
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24540-1240
Country	:	US
Telephone Number	:	434-836-2100
Fax Number	:	434-836-0021

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	07/08/2007

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