MEDICARE: DR. CHARLES EDWARD CREAGH JR. 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	207RP1001X	Pulmonary Disease Physician	11657	SC

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	:	1972596039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES EDWARD CREAGH JR. M.D.

Provider Business Mailing Address
First Line	:	124 GLENWOOD DR
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-1817
Country	:	US
Telephone Number	:	803-324-5280
Fax Number	:	803-328-0270

Provider Business Practice Location Address
First Line	:	124 GLENWOOD DR
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-1817
Country	:	US
Telephone Number	:	803-324-5280
Fax Number	:	803-328-0270

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	01/28/2011

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