Provider Demographics
NPI:1043310931
Name:KAVA, CHARLES F (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:F
Last Name:KAVA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 BEN PAUL LN
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-4452
Mailing Address - Country:US
Mailing Address - Phone:207-236-4444
Mailing Address - Fax:207-230-0524
Practice Address - Street 1:68 BEN PAUL LN
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4452
Practice Address - Country:US
Practice Address - Phone:207-236-4444
Practice Address - Fax:207-230-0524
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1108207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM5053Medicare ID - Type Unspecified
F67508Medicare UPIN