Provider Demographics
NPI:1275638694
Name:ADLER, CHARLTON LANCE (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHARLTON
Middle Name:LANCE
Last Name:ADLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 NE MIAMI GARDENS DR
Mailing Address - Street 2:235
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4707
Mailing Address - Country:US
Mailing Address - Phone:305-935-3999
Mailing Address - Fax:305-936-8231
Practice Address - Street 1:1380 NE MIAMI GARDENS DR
Practice Address - Street 2:235
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4707
Practice Address - Country:US
Practice Address - Phone:305-935-3999
Practice Address - Fax:305-936-8231
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1744213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029767400Medicaid
FLT55618Medicare UPIN
FL00064Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
FL87956ZMedicare ID - Type Unspecified