Healthcare Provider Details

I. General information

NPI: 1750279691
Provider Name (Legal Business Name): CHARLES WALTER WARD NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6503 DEER POINTE DR STE A
SALISBURY MD
21804-1674
US

IV. Provider business mailing address

201 DEFENSE HWY STE 205
ANNAPOLIS MD
21401-7096
US

V. Phone/Fax

Practice location:
  • Phone: 855-527-7246
  • Fax:
Mailing address:
  • Phone: 855-527-7246
  • Fax: 866-229-5063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLP-0010917
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberLP-0010917
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR244850
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: