Provider Demographics
NPI:1215755764
Name:CANNERCHARLES PLLC
Entity type:Organization
Organization Name:CANNERCHARLES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAUTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-523-0022
Mailing Address - Street 1:1201 LAKE JAMES DR STE 200
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-6780
Mailing Address - Country:US
Mailing Address - Phone:757-523-0022
Mailing Address - Fax:
Practice Address - Street 1:1129 COROLLA VILLAGE RD C
Practice Address - Street 2:
Practice Address - City:COROLLA
Practice Address - State:NC
Practice Address - Zip Code:27927
Practice Address - Country:US
Practice Address - Phone:252-597-1157
Practice Address - Fax:833-972-1688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care