Provider Demographics
NPI:1326228347
Name:NEMEROFF, CHARLES B (MD PHD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:B
Last Name:NEMEROFF
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 TRINITY ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78712-1765
Mailing Address - Country:US
Mailing Address - Phone:512-495-5728
Mailing Address - Fax:512-495-5482
Practice Address - Street 1:1601 TRINITY ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1765
Practice Address - Country:US
Practice Address - Phone:512-495-5728
Practice Address - Fax:512-495-5482
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0349162084P0800X
FLME 1081392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000474988EMedicaid
FL2228500Medicaid
FLDF459ZMedicare PIN
GA26BDBSLMedicare PIN