Provider Demographics
NPI:1114016839
Name:NEAGLE, CHARLES EDWARD (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDWARD
Last Name:NEAGLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4780 N JOSEY LN
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4615
Mailing Address - Country:US
Mailing Address - Phone:972-492-1334
Mailing Address - Fax:973-492-5174
Practice Address - Street 1:4780 N JOSEY LN
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4615
Practice Address - Country:US
Practice Address - Phone:972-492-1334
Practice Address - Fax:973-492-5174
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2706207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6484850003OtherMEDICARE NSC - EFFECT 02/01/2011
TXP00913358OtherMEDICARE RAILROAD - EFFECT 02/01/2011
TXTXB117510OtherMEDICARE PART B - EFFECT 02/01/2011
TX8B7876OtherBLUE CROSS BLUE SHIELD
TX8CR161OtherBCBS TX 02/01/2011
TX98971704Medicaid
TX4375780002Medicare NSC
TX8B7876OtherBLUE CROSS BLUE SHIELD
TXF37153Medicare UPIN
TXP00913358OtherMEDICARE RAILROAD - EFFECT 02/01/2011