Provider Demographics
NPI:1104861459
Name:WRIGHT, CHARLES MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:MICHAEL
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9888 GENESEE AVE
Mailing Address - Street 2:SUITE 780
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1205
Mailing Address - Country:US
Mailing Address - Phone:858-450-3388
Mailing Address - Fax:858-450-3157
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:SUITE 780
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1232
Practice Address - Country:US
Practice Address - Phone:858-450-3388
Practice Address - Fax:858-450-3157
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2016-10-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG 58919207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1104861459OtherNEIGHBORHOOD HEALTH PLAN
MA1104861459OtherHEALTH NET PLAN
MA1104861459OtherUNICARE
MA11787037OtherCAQH
MA2146711Medicaid
MAAA107087OtherHARVARD PILGRIM
MAJ42564OtherBLUE CROSS BLUE SHIELD
MA1104861459OtherBOSTON MEDICAL CENTER
MA1104861459OtherMEDICARE ID
MA1104861459OtherTUFTS HEALTH PLAN
MA1104861459OtherGREAT WEST HEALTHCARE
MA1104861459OtherNETWORK HEALTH
MA1104861459OtherHEALTH NET/ TRICARE NORTH
MA1104861459OtherCIGNA
MA1104861459OtherMEDICARE ID, TYPE UNSPECIFIED
MA1104861459OtherUNITED HEALTHCARE
MA1104861459OtherCIGNA