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General NPI Number Information
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NPI Number | 1386646107
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Entity Type | Individual
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Provider Name | CHARLES P VANDUYNE M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 4300 CITY POINT DRIVE SUITE 201
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City | NORTH RICHLAND HILLS
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State | TX
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Zip | 76180-8359
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Country | US
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Telephone | 817-284-8222
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Fax | 817-595-5718
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Provider Business Mailing Address
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Address Line | 4300 CITY POINT DRIVE SUITE 201
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City | NORTH RICHLAND HILLS
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State | TX
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Zip | 76180-8359
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Country | US
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Telephone | 817-284-8222
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Fax | 817-595-5718
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | H0020
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 135371
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License Number State | NY
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