Provider Demographics
NPI:1194773937
Name:CSIKY, CHARITA YIANGOPOULLOU (MD)
Entity type:Individual
Prefix:DR
First Name:CHARITA
Middle Name:YIANGOPOULLOU
Last Name:CSIKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHARITA (RITA)
Other - Middle Name:
Other - Last Name:YIANGOPOULLOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 602530
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2530
Mailing Address - Country:US
Mailing Address - Phone:910-640-4064
Mailing Address - Fax:910-640-4063
Practice Address - Street 1:612 JEFFERSON ST
Practice Address - Street 2:SUITE 28
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3708
Practice Address - Country:US
Practice Address - Phone:910-640-4064
Practice Address - Fax:910-640-4063
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07792700208000000X
NC2013-01180208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC2010Medicaid
NC1194773937Medicaid