Provider Demographics
NPI:1174630529
Name:ABLAN, CHARLES JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOHN
Last Name:ABLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4264 BRAEMERE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-0682
Mailing Address - Country:US
Mailing Address - Phone:352-596-1513
Mailing Address - Fax:352-596-5918
Practice Address - Street 1:14540 CORTEZ BLVD
Practice Address - Street 2:SUITE 123
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6056
Practice Address - Country:US
Practice Address - Phone:352-596-1513
Practice Address - Fax:352-596-5918
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4352208G00000X
WI35260208G00000X
FL106333208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00426308OtherRAILROAD MEDICARE
BA1784241OtherDEA
F79072Medicare UPIN