Provider Demographics
NPI:1528164746
Name:MUNCRIEF, CHARLES (DO)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:MUNCRIEF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4817 AVONDALE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-8623
Mailing Address - Country:US
Mailing Address - Phone:614-789-9345
Mailing Address - Fax:
Practice Address - Street 1:90 VILLAGE POINTE DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7760
Practice Address - Country:US
Practice Address - Phone:614-791-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34 0073852085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH300126993OtherRAILROAD MEDICARE - MOR
OHP00292383OtherRAILROAD MEDICARE UCI
OHG54106Medicare UPIN