MEDICARE: DR. CHARLES A MIDDELHOF M.D.

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	0101239873	VA

General Provider Information

NPI Number	:	1750586236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES A MIDDELHOF M.D.

Provider Business Mailing Address
First Line	:	426 ALBIN DR
Second Line	:
City	:	STEPHENS CITY
State	:	VA
Zip	:	22655-5946
Country	:	US
Telephone Number	:	540-247-7299
Fax Number	:

Provider Business Practice Location Address
First Line	:	640 WARRIOR DR
Second Line	:	SUITE 109
City	:	STEPHENS CITY
State	:	VA
Zip	:	22655-4076
Country	:	US
Telephone Number	:	540-868-2511
Fax Number	:

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

Provider Enumeration Date	:	06/15/2007
Last Update Date	:	03/14/2008

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