MEDICARE: CHARLES CODDINGTON III 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	207V00000X	Obstetrics & Gynecology Physician	52044	SC
2	207V00000X	Obstetrics & Gynecology Physician	2018-01047	NC
3	207VE0102X	Reproductive Endocrinology Physician	2018-0147	NC

General Provider Information

NPI Number	:	1659359040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES CODDINGTON III MD

Provider Business Mailing Address
First Line	:	PO BOX 19305
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28219-9305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1025 MOREHEAD MEDICAL DR
Second Line	:	STE 500 5TH FLOOR
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2963
Country	:	US
Telephone Number	:	704-355-3149
Fax Number	:

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

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	08/23/2022

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