Provider Demographics
NPI:1073813291
Name:KING, CHARLES RUSSELL (CP)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:RUSSELL
Last Name:KING
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 PARK ST
Mailing Address - Street 2:SUITE 252
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3172
Mailing Address - Country:US
Mailing Address - Phone:301-707-0982
Mailing Address - Fax:
Practice Address - Street 1:52 MARION ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2548
Practice Address - Country:US
Practice Address - Phone:301-707-0982
Practice Address - Fax:301-724-5050
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist