Provider Demographics
NPI:1093912180
Name:MASKINY, CHARBEL F (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARBEL
Middle Name:F
Last Name:MASKINY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3245 HEALTH DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-3245
Mailing Address - Country:US
Mailing Address - Phone:574-647-1840
Mailing Address - Fax:
Practice Address - Street 1:621 MEMORIAL DRIVE
Practice Address - Street 2:SUITE 512
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1075
Practice Address - Country:US
Practice Address - Phone:574-246-9350
Practice Address - Fax:574-246-9376
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01071462A207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201121390Medicaid
IN201121390Medicaid
INP01194461Medicare PIN
IN201121390Medicaid
IN000000778584OtherANTHEM BCBS