Healthcare Provider Details

I. General information

NPI: 1063467884
Provider Name (Legal Business Name): CHARLES W PLUMMER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 W MEDICAL PARK DR
LEXINGTON NC
27292-6773
US

IV. Provider business mailing address

114 W MEDICAL PARK DR
LEXINGTON NC
27292-6773
US

V. Phone/Fax

Practice location:
  • Phone: 336-249-8760
  • Fax: 336-249-2710
Mailing address:
  • Phone: 336-249-8760
  • Fax: 336-249-2710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number24982
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number24982
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number24982
License Number StateNC

VIII. Authorized Official

Name: MRS. PENNY H. LOVELACE
Title or Position: OFFICE MANAGER
Credential:
Phone: 336-249-8760