Provider Demographics
NPI:1225007016
Name:HOUSE, CHARLES P SR (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:P
Last Name:HOUSE
Suffix:SR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-0179
Mailing Address - Country:US
Mailing Address - Phone:440-274-5000
Mailing Address - Fax:440-716-8608
Practice Address - Street 1:420 W MCPHERSON HWY
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:OH
Practice Address - Zip Code:43410-1133
Practice Address - Country:US
Practice Address - Phone:419-547-0584
Practice Address - Fax:419-547-8918
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-007179207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000351615OtherANTHEM
OH20711612OtherUNITED HEALTHCARE
OH58182OtherNATIONWIDE HEALTH PLAN
OHP00180079OtherRAILROAD MEDICARE
OH04663OtherPARAMOUNT
OH2158472Medicaid
OH2158472Medicaid
OHP00180079OtherRAILROAD MEDICARE