Provider Demographics
NPI:1245213123
Name:BELLINGHAM, CHARLES EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDWARD
Last Name:BELLINGHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 JACK MARTIN BLVD
Mailing Address - Street 2:SUITE E4
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7772
Mailing Address - Country:US
Mailing Address - Phone:732-840-4300
Mailing Address - Fax:732-840-4515
Practice Address - Street 1:224 JACK MARTIN BLVD
Practice Address - Street 2:SUITE E4
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7772
Practice Address - Country:US
Practice Address - Phone:732-840-4300
Practice Address - Fax:732-840-4515
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1638009Medicaid
NJ108242BSEMedicare ID - Type Unspecified
NJ1638009Medicaid