Basic Information
Provider Information
NPI: 1356410971
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FRIEL
FirstName: CHARLES
MiddleName: M.
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 9007
Address2:  
City: CHARLOTTESVILLE
State: VA
PostalCode: 229069007
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1215 LEE ST FL 1
Address2:  
City: CHARLOTTESVILLE
State: VA
PostalCode: 229080816
CountryCode: US
TelephoneNumber: 4342439971
FaxNumber: 4349821024
Other Information
ProviderEnumerationDate: 11/07/2006
LastUpdateDate: 03/20/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X0101231279VAY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


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