Healthcare Provider Details

I. General information

NPI: 1952371460
Provider Name (Legal Business Name): CHARLES L EGAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BREWSTER BLVD
CAMP LEJEUNE NC
28547-2575
US

IV. Provider business mailing address

100 BREWSTER BLVD
CAMP LEJEUNE NC
28547-2575
US

V. Phone/Fax

Practice location:
  • Phone: 619-302-2777
  • Fax:
Mailing address:
  • Phone: 619-302-2777
  • Fax: 910-450-4452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number20A16281
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: