Provider Demographics
NPI:1184794646
Name:BEASLEY, CHARLES BRITTON
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:BRITTON
Last Name:BEASLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-2644
Mailing Address - Country:US
Mailing Address - Phone:252-527-7522
Mailing Address - Fax:
Practice Address - Street 1:701 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1584
Practice Address - Country:US
Practice Address - Phone:252-523-0687
Practice Address - Fax:252-523-0255
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20464207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC040008806OtherMEDICARE RAILROAD
NC8914158Medicaid
NC8914158Medicaid
NCC82755Medicare UPIN