Provider Demographics
NPI:1184993784
Name:BELL, CHARLES WESLEY (PA)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:WESLEY
Last Name:BELL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:935 SHOTWELL RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-5597
Mailing Address - Country:US
Mailing Address - Phone:919-550-0821
Mailing Address - Fax:919-719-3645
Practice Address - Street 1:5156 NC HIGHWAY 42 W
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-8417
Practice Address - Country:US
Practice Address - Phone:919-329-5000
Practice Address - Fax:919-329-5300
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03286363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-03286OtherMEDICAL LICENSE