MEDICARE: DR. CHARLES T MARSTON JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	23862	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215914627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES T MARSTON JR. MD

Provider Business Mailing Address
First Line	:	8712 PLANTATION DR
Second Line	:	PO BOX 4429
City	:	EMERALD ISLE
State	:	NC
Zip	:	28594-1918
Country	:	US
Telephone Number	:	336-963-9066
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 NORTH MAIN STREET
Second Line	:
City	:	KENANSVILLE
State	:	NC
Zip	:	28349-0278
Country	:	US
Telephone Number	:	336-963-9066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	01/13/2010

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