Healthcare Provider Details

I. General information

NPI: 1508831645
Provider Name (Legal Business Name): CHARLES E WILHELM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 IRONBOUND RD STE 201
WILLIAMSBURG VA
23188
US

IV. Provider business mailing address

4125 IRONBOUND RD STE 201
WILLIAMSBURG VA
23188
US

V. Phone/Fax

Practice location:
  • Phone: 757-253-0603
  • Fax: 757-253-0646
Mailing address:
  • Phone: 757-253-0603
  • Fax: 757-253-0646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101033927
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: