Provider Demographics
NPI:1346382652
Name:SARASOHN, CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:SARASOHN
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 1:6500 PRESTON HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-1820
Mailing Address - Country:US
Mailing Address - Phone:502-893-5502
Mailing Address - Fax:502-721-8655
Practice Address - Street 1:4121 DUTCHMANS LN
Practice Address - Street 2:SUITE 415
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4707
Practice Address - Country:US
Practice Address - Phone:502-893-5502
Practice Address - Fax:502-894-0836
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17044208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1049812OtherPASSPORT
KY000000050239OtherANTHEM
KY1072558OtherPASSPORT
KY1049803OtherPASSPORT
KY1050067OtherPASSPORT
KY64170442Medicaid
KY1072558OtherPASSPORT