Provider Demographics
NPI:1326115866
Name:KING, CHARLES LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LAWRENCE
Last Name:KING
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 1:20 BRIDGE STREET
Mailing Address - Street 2:
Mailing Address - City:FRENCHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08825-1227
Mailing Address - Country:US
Mailing Address - Phone:908-996-4003
Mailing Address - Fax:908-996-3563
Practice Address - Street 1:20 BRIDGE STREET
Practice Address - Street 2:
Practice Address - City:FRENCHTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08825-1227
Practice Address - Country:US
Practice Address - Phone:908-996-4003
Practice Address - Fax:908-996-3563
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02618300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3725006Medicaid
G66719Medicare UPIN
NJ3725006Medicaid