Provider Demographics
NPI:1083764351
Name:FIELDS, CHARLES MITCHELL (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:MITCHELL
Last Name:FIELDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6759 STATE ROUTE 159
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-9197
Mailing Address - Country:US
Mailing Address - Phone:740-775-7778
Mailing Address - Fax:
Practice Address - Street 1:4457 STATE ROUTE 159
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8620
Practice Address - Country:US
Practice Address - Phone:740-775-7771
Practice Address - Fax:740-775-7791
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH45193207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0560156Medicaid
OH0560156Medicaid