Provider Demographics
NPI:1215914627
Name:MARSTON, CHARLES T JR (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:T
Last Name:MARSTON
Suffix:JR
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 1:8712 PLANTATION DR
Mailing Address - Street 2:PO BOX 4429
Mailing Address - City:EMERALD ISLE
Mailing Address - State:NC
Mailing Address - Zip Code:28594-1918
Mailing Address - Country:US
Mailing Address - Phone:336-963-9066
Mailing Address - Fax:
Practice Address - Street 1:401 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:KENANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28349-0278
Practice Address - Country:US
Practice Address - Phone:336-963-9066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23862208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8954119Medicaid
NCC82034Medicare UPIN