Provider Demographics
NPI:1003975582
Name:MARCELO, CHARITO (MD)
Entity Type:Individual
Prefix:
First Name:CHARITO
Middle Name:
Last Name:MARCELO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHARITO
Other - Middle Name:
Other - Last Name:QUIAMBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1829 CEDAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-3161
Mailing Address - Country:US
Mailing Address - Phone:405-364-7726
Mailing Address - Fax:
Practice Address - Street 1:320 12TH AVE NE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-5238
Practice Address - Country:US
Practice Address - Phone:405-573-3821
Practice Address - Fax:405-573-8256
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK114782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1111478Medicaid