Individual
CHARLES A DECOMARMOND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2004-01489
NC
207RI0200X
Infectious Disease Physician
Primary
2004-01489
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10231141
—
VA
01
—
141NK
BCBS
NC
01
—
185411
MEDCOST
NC
05
—
3810004336
—
WV
05
—
5901136
—
NC
01
—
7931787
AETNA
NC
01
—
807307
PARTNERS
NC
05
—
Q01481
—
SC
Enumeration date
01/18/2006
Last updated
04/28/2008
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