Provider Demographics
NPI:1043420169
Name:MURDOCK, CHARLES CESARE (LICAC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:CESARE
Last Name:MURDOCK
Suffix:
Gender:M
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 TILLEY DR
Mailing Address - Street 2:SUITE 50
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-4484
Mailing Address - Country:US
Mailing Address - Phone:802-985-8800
Mailing Address - Fax:
Practice Address - Street 1:185 TILLEY DR
Practice Address - Street 2:SUITE 50
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-4484
Practice Address - Country:US
Practice Address - Phone:802-985-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091-0000064171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist