Provider Demographics
NPI:1346268745
Name:DUNHAM, CHARLES KENDRICK (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:KENDRICK
Last Name:DUNHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:K
Other - Last Name:DUNHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3388 PRINCESS ANNE RD STE 2001
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-2612
Mailing Address - Country:US
Mailing Address - Phone:757-507-7270
Mailing Address - Fax:
Practice Address - Street 1:3388 PRINCESS ANNE RD STE 2001
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-2612
Practice Address - Country:US
Practice Address - Phone:757-507-7270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01758207R00000X, 208M00000X
NC2005017582084P0800X
VA01012770932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910376Medicaid