Provider Demographics
NPI:1346259470
Name:MAGICH, CHARLES B JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:B
Last Name:MAGICH
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 64795
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4795
Mailing Address - Country:US
Mailing Address - Phone:410-328-6704
Mailing Address - Fax:410-328-4124
Practice Address - Street 1:3001 CORAL SPRINGS DRIVE
Practice Address - Street 2:STE 200
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4172
Practice Address - Country:US
Practice Address - Phone:954-837-1201
Practice Address - Fax:954-752-1660
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR108865367500000X
FLAPRN11002490367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104763500Medicaid
MD213307500Medicaid
MDS71373Medicare UPIN
MD213307500Medicaid