Provider Demographics
NPI:1972596039
Name:CREAGH, CHARLES EDWARD JR (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDWARD
Last Name:CREAGH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:124 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1817
Mailing Address - Country:US
Mailing Address - Phone:803-324-5280
Mailing Address - Fax:803-328-0270
Practice Address - Street 1:124 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1817
Practice Address - Country:US
Practice Address - Phone:803-324-5280
Practice Address - Fax:803-328-0270
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2011-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC11657207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1513Medicaid
SCC68861Medicare UPIN