Provider Demographics
NPI:1023546413
Name:BINGHAM, CHARLES WAYNE (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WAYNE
Last Name:BINGHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:204 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1431
Mailing Address - Country:US
Mailing Address - Phone:570-867-1617
Mailing Address - Fax:
Practice Address - Street 1:132 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-8107
Practice Address - Country:US
Practice Address - Phone:570-265-6165
Practice Address - Fax:570-265-3616
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS021240207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine