Provider Demographics
NPI:1487603858
Name:SHALLER, CHARLES ALVA (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ALVA
Last Name:SHALLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:36 WESTGATE PLZ
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28734-1422
Mailing Address - Country:US
Mailing Address - Phone:828-369-4236
Mailing Address - Fax:828-369-0753
Practice Address - Street 1:36 WESTGATE PLZ
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734
Practice Address - Country:US
Practice Address - Phone:828-369-4236
Practice Address - Fax:828-369-0753
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400350207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8975409Medicaid
NCE87784Medicare UPIN
NC8975409Medicaid
2195133Medicare ID - Type Unspecified