Provider Demographics
NPI:1346226388
Name:ABBOTTSMITH, CHARLES W (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:ABBOTTSMITH
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 1:237 WILLIAM HOWARD TAFT RD
Mailing Address - Street 2:2ND FLOOR, CBO 2-3
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2610
Mailing Address - Country:US
Mailing Address - Phone:513-206-1060
Mailing Address - Fax:513-206-1062
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:SUITE 139
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-206-1060
Practice Address - Fax:513-206-1062
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35029506207RC0000X
OH35.029506207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64787617Medicaid
IN100009840Medicaid
283677OtherAMERIGROUP
OH641388OtherAETNA
OH29506-05OtherHUMANA CHOICECARE
OH000000019879OtherANTHEM CINCINNATI
OH0380083Medicaid
060033890OtherRAILROAD MEDICARE
2520405OtherUNITED HEALTHCARE
OH000000238154OtherANTHEM MIDDLETOWN
KY64787617Medicaid
OH0380083Medicaid
283677OtherAMERIGROUP
OH641388OtherAETNA