Provider Demographics
NPI:1144316936
Name:CHARLES A RAUGH DPM PC
Entity type:Organization
Organization Name:CHARLES A RAUGH DPM PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:RAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:202-628-2230
Mailing Address - Street 1:1800 I ST NW
Mailing Address - Street 2:SUITE 503B
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-5407
Mailing Address - Country:US
Mailing Address - Phone:202-628-2230
Mailing Address - Fax:
Practice Address - Street 1:1800 I ST NW
Practice Address - Street 2:SUITE 503B
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-5407
Practice Address - Country:US
Practice Address - Phone:202-628-2230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPO347213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
066651OtherANTHEM BCBS OF VIRGINIA
066651OtherANTHEM BCBS OF VIRGINIA