Healthcare Provider Details

I. General information

NPI: 1881804268
Provider Name (Legal Business Name): CHARLES E OBIAJA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 SALISBURY ST ANSON REGIONAL MEDICAL SERVICES INC.
WADESBORO NC
28170-2155
US

IV. Provider business mailing address

203 SALISBURY ST ANSON REGIONAL MEDICAL SERVICES INC.
WADESBORO NC
28170-2155
US

V. Phone/Fax

Practice location:
  • Phone: 704-695-1360
  • Fax: 704-695-1227
Mailing address:
  • Phone: 704-695-1360
  • Fax: 704-695-1227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2008-01467
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: