Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 38754 | NC |
NPI | 1063412138 |
---|---|
Provider Name | Dr. Charles W Daeschner III |
First Address | Charlotte, NC 28275-1069 |
Second Address | Greenville, NC 27834-4300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 02/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2672B | BCBS NC (01) | NC |
830006204 | RAILROAD MEDICARE (01) | NC |
892672B | (05) | NC |
C14975 | (02) | NC |