Individual
CHARLES HERMAN TEGELER IV
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
(336) 716-9016
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
(336) 716-9016
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
38221
NC
2084V0102X
Vascular Neurology Physician
38221
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130025126
RR MEDICARE
—
05
—
2006823000
—
WV
01
—
48771
MEDCOST
—
01
—
5009152
AETNA
—
01
—
5617
PARTNERS
—
05
—
6100805
—
VA
01
—
82352
BCBS
—
05
—
8982352
—
NC
05
—
Q38221
—
SC
Enumeration date
12/20/2005
Last updated
11/12/2010
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