MEDICARE: DR. CHARLES EDWARD MCBRIDE M.D.

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	174400000X	Specialist	0101047013	VA

General Provider Information

NPI Number	:	1831124197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES EDWARD MCBRIDE M.D.

Provider Business Mailing Address
First Line	:	9257 OLD KEENE MILL RD
Second Line	:
City	:	BURKE
State	:	VA
Zip	:	22015-4202
Country	:	US
Telephone Number	:	703-455-5556
Fax Number	:	703-455-4587

Provider Business Practice Location Address
First Line	:	9257 OLD KEENE MILL ROAD
Second Line	:
City	:	BURKE
State	:	VA
Zip	:	22015-4202
Country	:	US
Telephone Number	:	703-455-5556
Fax Number	:	703-455-4587

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	03/07/2023

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