Healthcare Provider Details

I. General information

NPI: 1457315921
Provider Name (Legal Business Name): CHARLES A ESHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 GREENLEAF DR SUITE A
WILMINGTON DE
19810-2413
US

IV. Provider business mailing address

2401 GREENLEAF DR SUITE A
WILMINGTON DE
19810-2413
US

V. Phone/Fax

Practice location:
  • Phone: 302-475-6600
  • Fax: 302-475-6614
Mailing address:
  • Phone: 302-475-6600
  • Fax: 302-475-6614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberC1-0003508
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: