Provider Demographics
NPI:1861547085
Name:CHARLES J. DEPAOLO, M.D, P.A.
Entity type:Organization
Organization Name:CHARLES J. DEPAOLO, M.D, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:GWENN
Authorized Official - Middle Name:PEMBERTON
Authorized Official - Last Name:STINNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-254-7180
Mailing Address - Street 1:3B MCDOWELL ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4103
Mailing Address - Country:US
Mailing Address - Phone:828-225-1920
Mailing Address - Fax:828-225-1924
Practice Address - Street 1:3B MCDOWELL ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4103
Practice Address - Country:US
Practice Address - Phone:828-225-1920
Practice Address - Fax:828-225-1924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001253733174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7928350Medicaid
NC6257890001Medicare NSC
NC7928350Medicaid
NC2345594Medicare PIN
2172051AMedicare ID - Type Unspecified