Provider Demographics
NPI:1164425138
Name:BEMIS, CHARLES E (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:BEMIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9501 ROOSEVELT BLVD
Mailing Address - Street 2:STE 305
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1028
Mailing Address - Country:US
Mailing Address - Phone:215-671-4280
Mailing Address - Fax:215-464-9034
Practice Address - Street 1:1650 HUNTINGDON PIKE
Practice Address - Street 2:STE 352
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8009
Practice Address - Country:US
Practice Address - Phone:215-947-9218
Practice Address - Fax:215-947-9103
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD014182E207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007560690002Medicaid
PA115298NYVMedicare ID - Type Unspecified
PA0007560690002Medicaid