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General NPI Number Information
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NPI Number | 1063412138
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Entity Type | Individual
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Provider Name | CHARLES W DAESCHNER III MD
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Gender | Male
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Dates
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Enumeration Date | 07/29/2005
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Last Update Date | 11/02/2011
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Provider Practice Location Address
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Address Line | 600 MOYE BLVD ECU PHYSICIANS PEDIATRIC OUTPATIENT CENTER
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City | GREENVILLE
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State | NC
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Zip | 27834-4300
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Country | US
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Telephone | 252-744-2335
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Fax | 252-744-3811
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Provider Business Mailing Address
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Address Line | PO BOX 751069
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City | CHARLOTTE
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State | NC
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Zip | 28275-1069
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Country | US
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Telephone | 252-744-3520
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Fax | 252-744-3194
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0207X
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Taxonomy Name | Pediatric Hematology & Oncology Physician
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License Number | 38754
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License Number State | NC
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