Basic Information
| Provider Information | |||||||||
| NPI: | 1124108303 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANENE | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | AZUBUIKE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 63362 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282633362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007826945 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 W 27TH ST | ||||||||
| Address2: | |||||||||
| City: | LUMBERTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283583075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106715000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 10/26/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | MD066370L | PA | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | 25MA06518800 | NJ | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208600000X | 2016-02042 | NC | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0071575000 | 01 | AMERIHEALTH | OTHER | 012207 | 01 | NJ | MEDICARE | OTHER | 2372299 | 01 | AETNA | OTHER | 8438706 | 01 | NJ MEDICAL ASSISTANCE | OTHER | 0152107202 | 01 | AMERICHOICE | OTHER | 1125019 | 01 | KEYSTONE MERCY HEALTH PLA | OTHER | 8211867002 | 01 | CIGNA | OTHER | 019033 | 01 | HIGHMARK | OTHER | 0071575000 | 01 | IBC | OTHER | 001820720001 | 05 | PA | MEDICAID | 330005393 | 01 | RAILROAD MEDICARE | OTHER |