MEDICARE: CHARLES LEON BRANCH 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	207T00000X	Neurological Surgery Physician	27027	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	140007841	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	21297	OTHER	MEDCOST
2	2801	OTHER	PARTNERS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	17801	OTHER	BCBS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	4607330	OTHER	AETNA

General Provider Information

NPI Number	:	1821078403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES LEON BRANCH JR. MD

Provider Business Mailing Address
First Line	:	690 BURTON RD
Second Line	:
City	:	ADVANCE
State	:	NC
Zip	:	27006-7506
Country	:	US
Telephone Number	:	336-978-8878
Fax Number	:

Provider Business Practice Location Address
First Line	:	690 BURTON RD
Second Line	:
City	:	ADVANCE
State	:	NC
Zip	:	27006-7506
Country	:	US
Telephone Number	:	336-978-8878
Fax Number	:

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	12/07/2024

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Directions to “ CHARLES LEON BRANCH JR. MD” Practice Location

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