MEDICARE: DR. CHARLES W STAFFORD 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	207Q00000X	Family Medicine Physician	29676	NC

General Provider Information

NPI Number	:	1518932763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES W STAFFORD MD

Provider Business Mailing Address
First Line	:	PO BOX 986513
Second Line	:	DEPT 100
City	:	BOSTON
State	:	MA
Zip	:	02298-6513
Country	:	US
Telephone Number	:	910-219-8326
Fax Number	:	910-939-4269

Provider Business Practice Location Address
First Line	:	3004 BRIDGES ST
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-3330
Country	:	US
Telephone Number	:	252-727-4933
Fax Number	:	252-727-4936

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	11/06/2023

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