Basic Information
| Provider Information | |||||||||
| NPI: | 1407810351 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FELTON | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3073 WHITE MOUNTAIN HWY | ||||||||
| Address2: | MEMORIAL HOSPITAL | ||||||||
| City: | NORTH CONWAY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038607101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033565461 | ||||||||
| FaxNumber: | 6033565877 | ||||||||
| Practice Location | |||||||||
| Address1: | 3073 WHITE MOUNTAIN HWY | ||||||||
| Address2: | MEMORIAL HOSPITAL | ||||||||
| City: | NORTH CONWAY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038607101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033565461 | ||||||||
| FaxNumber: | 6033565877 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2006 | ||||||||
| LastUpdateDate: | 03/10/2016 | ||||||||
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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 | 208M00000X | 6863 | NH | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RC0200X | 6863 | NH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 6863 | NH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207R00000X | 6863 | NH | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | T400207036 | 01 | NH | MEDICARE PTAN | OTHER | 3090824 | 05 | NH | MEDICAID |