Provider Demographics
NPI:1285709691
Name:PLUMMER, CHARLES WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WAYNE
Last Name:PLUMMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8606 YVONNE CT
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:27310-0150
Mailing Address - Country:US
Mailing Address - Phone:336-870-5084
Mailing Address - Fax:336-441-8700
Practice Address - Street 1:530 N ELAM AVE
Practice Address - Street 2:SUITE C
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1153
Practice Address - Country:US
Practice Address - Phone:336-285-7853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24982207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC86012Medicare UPIN