Provider Demographics
NPI:1033114749
Name:CLINE, CHARLES W (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:CLINE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1200 BROOKS LANE
Mailing Address - Street 2:170
Mailing Address - City:JEFFERSON HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3749
Mailing Address - Country:US
Mailing Address - Phone:412-469-7110
Mailing Address - Fax:412-469-8965
Practice Address - Street 1:1200 BROOKS LANE
Practice Address - Street 2:170
Practice Address - City:JEFFERSON HILLS
Practice Address - State:PA
Practice Address - Zip Code:15025-3749
Practice Address - Country:US
Practice Address - Phone:412-469-7110
Practice Address - Fax:412-469-8965
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2020-10-05
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Provider Licenses
StateLicense IDTaxonomies
PAMD031665E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA175036OtherHIGHMARK BC BS
PA1003711OtherGATEWAY HEALTH PLAN
PA1003711OtherGATEWAY HEALTH PLAN
PAC32823Medicare UPIN