Provider Demographics
NPI:1003926270
Name:LAW, CHARLES R (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:LAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OSLO CIR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-5965
Mailing Address - Country:US
Mailing Address - Phone:205-944-3944
Mailing Address - Fax:205-944-3964
Practice Address - Street 1:120 OSLO CIR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-5965
Practice Address - Country:US
Practice Address - Phone:205-944-3944
Practice Address - Fax:205-413-4914
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.209682081P0010X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06989317Medicaid
ALG40410OtherVIVA HEALTH
AL009948670Medicaid
AL131757Medicaid
AL511-17174OtherBCBS
G40410Medicare UPIN
AL102I378123Medicare PIN
AL511-17174OtherBCBS