Provider Demographics
NPI:1306864483
Name:BRIDGES, CHARLES R (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:BRIDGES
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 1:106 PINE ST
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-1308
Mailing Address - Country:US
Mailing Address - Phone:610-247-2986
Mailing Address - Fax:704-372-1249
Practice Address - Street 1:106 PINE ST
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:MA
Practice Address - Zip Code:02466-1308
Practice Address - Country:US
Practice Address - Phone:610-247-2986
Practice Address - Fax:704-372-1249
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011-01426208600000X, 208G00000X
PAMD031335E208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5917485Medicaid
SCNC1469Medicaid
PA001588610Medicaid
NC5917485Medicaid
PAB34265Medicare UPIN
SCNC1469Medicaid