Provider Demographics
NPI:1225697451
Name:DURHAM, CHARITY (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARITY
Middle Name:
Last Name:DURHAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CHARITY
Other - Middle Name:
Other - Last Name:ORRISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:95 SCOVILL ST
Mailing Address - Street 2:STE 203
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1113
Mailing Address - Country:US
Mailing Address - Phone:229-292-1144
Mailing Address - Fax:
Practice Address - Street 1:2446 ALBANY AVE STE 302
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2522
Practice Address - Country:US
Practice Address - Phone:229-292-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY153-T2207Q00000X
CT70567207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine