Provider Demographics
NPI:1366472748
Name:SCHATZ, CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:SCHATZ
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 1:1516 COTNER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3303
Mailing Address - Country:US
Mailing Address - Phone:310-445-2951
Mailing Address - Fax:310-479-1459
Practice Address - Street 1:1516 COTNER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3303
Practice Address - Country:US
Practice Address - Phone:310-445-2951
Practice Address - Fax:310-479-1459
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG180622085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G180620Medicaid
CAGR0106031Medicaid
CAWG18062NNMedicare PIN
CA00G180626Medicare PIN
CA00G180627Medicare PIN
CA00G180623Medicare PIN
CAWG18062BBMedicare PIN
CAWG18062LLMedicare PIN
CAWG18062AMedicare PIN
CA00G180622Medicare PIN
CAWG18062CCMedicare PIN
CAWG18062KKMedicare PIN
CA00G180624Medicare PIN
CA00G180621Medicare PIN
CA00G180620Medicaid
CAGR0106031Medicaid
CAWG18062MMMedicare PIN
CA00G180625Medicare PIN