Provider Demographics
NPI:1164419602
Name:SAWYER, CHARLES M (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:M
Last Name:SAWYER
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 1:243 ELM ST
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743-4921
Mailing Address - Country:US
Mailing Address - Phone:603-542-7771
Mailing Address - Fax:
Practice Address - Street 1:243 ELM ST
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-4921
Practice Address - Country:US
Practice Address - Phone:603-542-7771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA273460207Q00000X
NH10346207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0RE5070Medicaid
NH384626OtherMVP
MA110140679AMedicaid
NHAA66299OtherHPHC
VT00038539OtherBCBSVT
NH2597500OtherCIGNA
NH30200038Medicaid
NH30200038Medicaid