Provider Demographics
NPI:1144325077
Name:BEEMER, CHARLES THEODORE (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:THEODORE
Last Name:BEEMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-9763
Mailing Address - Country:US
Mailing Address - Phone:919-499-3021
Mailing Address - Fax:
Practice Address - Street 1:102 RIVIERA DR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-9763
Practice Address - Country:US
Practice Address - Phone:919-499-3021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29074207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC14358OtherBCBSNC
NC8914358Medicaid
NC1144325077Medicaid
NC14358OtherBCBSNC
NC204708AMedicare ID - Type Unspecified
NC8914358Medicaid