Provider Demographics
NPI:1184658148
Name:WAX, CHARLES MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:MICHAEL
Last Name:WAX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1617 N BEND RD
Mailing Address - Street 2:
Mailing Address - City:JARRETTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21084-1329
Mailing Address - Country:US
Mailing Address - Phone:410-838-1051
Mailing Address - Fax:410-838-5325
Practice Address - Street 1:2 COLGATE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-2624
Practice Address - Country:US
Practice Address - Phone:410-838-1051
Practice Address - Fax:410-838-5325
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2008-09-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD00245422080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD290708OtherALLIANCE PPO
67160OtherPRIVATE HEALTHCARE SYSTEM
MD010183OtherEMPLOYEE HEALTH PLAN
MD290708OtherMD-IPA
CT3711148OtherCIGNA HEALTHCARE
MD1930001OtherBXBS FEDERAL
DE34076OtherCOVENTRY HEALTHCARE
DC494353OtherNATIONAL CAPITOL PPO
DC1930001OtherBXBS BLUE CHOICE HMO
MD290708OtherOPTIMUM CHOICE HMO
MD290708OtherUNITED HEALTHCARE
MD8905CMOtherMARYLAND BXBS
MD010183OtherJOHNS HOPKINS HEALTH PLAN
MD290708OtherMAMSI LIFE AND HEALTH
PA4217234OtherAETNA HEALTHCARE