Provider Demographics
NPI:1225373731
Name:CHARLES MASTER MD PC
Entity Type:Organization
Organization Name:CHARLES MASTER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:P
Authorized Official - Last Name:MATER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-792-1777
Mailing Address - Street 1:4310 KISSENA BLVD
Mailing Address - Street 2:APT 15D
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2922
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4310 KISSENA BLVD
Practice Address - Street 2:APT 15D
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2922
Practice Address - Country:US
Practice Address - Phone:860-792-1777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty