Active NPI
Charles Wesley Lallier, MD
- Pediatrics Physician
- Durham, NC
National Provider Identifier
1669437828
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 28057
- Practice address
- 4022 Freedom Lake Dr
Durham, NC 27704 - Phone
- (919) 477-2202
- Fax
- (919) 471-2270
- NPI assigned
- Apr 19, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 28057 | NC | Primary |
Addresses
Primary practice location
4022 Freedom Lake Dr
Durham, NC 27704
Mailing address
4022 Freedom Lake Dr
Durham, NC 27704
Phone (919) 477-2202
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 50624 | Other | NC | BSBC STATE FEDERAL NC HEA |
| 4221816 | Other | AETNA | |
| 269611 | Other | MAMSI ALLIANCE | |
| 1250106 | Other | UNITED HEALTHCARE | |
| 8950624 | Medicaid | NC | |
| 50121 | Other | MEDCOST | |
| 8950624 | Other | CAROLINA ACCESS NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28057 | NC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1296086400000",
"number": "1669437828",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4022 FREEDOM LAKE DR",
"city": "DURHAM",
"state": "NC",
"postal_code": "27704",
"telephone_number": "919-477-2202",
"fax_number": "919-471-2270"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4022 FREEDOM LAKE DR",
"city": "DURHAM",
"state": "NC",
"postal_code": "27704",
"telephone_number": "919-477-2202",
"fax_number": "919-471-2270"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LALLIER",
"first_name": "CHARLES",
"middle_name": "WESLEY",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-19",
"last_updated": "2011-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NC",
"license": "28057",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BSBC STATE FEDERAL NC HEA",
"identifier": "50624",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4221816",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAMSI ALLIANCE",
"identifier": "269611",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "1250106",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8950624",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST",
"identifier": "50121",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAROLINA ACCESS NC",
"identifier": "8950624",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Durham, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.