Provider Demographics
NPI:1265864136
Name:MARBURGER-CADDO, CHARITY L
Entity Type:Individual
Prefix:MRS
First Name:CHARITY
Middle Name:L
Last Name:MARBURGER-CADDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 NW ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-6309
Mailing Address - Country:US
Mailing Address - Phone:580-583-3108
Mailing Address - Fax:
Practice Address - Street 1:1802 NW ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507-6309
Practice Address - Country:US
Practice Address - Phone:580-583-3108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor