Provider Demographics
NPI:1376555946
Name:SACKS, CHARLES B (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:B
Last Name:SACKS
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:PO BOX 6305
Mailing Address - Street 2:1313 VINCENT PL
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22106
Mailing Address - Country:US
Mailing Address - Phone:703-821-1017
Mailing Address - Fax:703-799-1053
Practice Address - Street 1:1313 VINCENT PL
Practice Address - Street 2:
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101
Practice Address - Country:US
Practice Address - Phone:703-821-1017
Practice Address - Fax:703-799-1053
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0284512084P0800X
MDD198622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC8006OtherCAREFIRST BCBS
VA082435OtherANTHEM BCBS
MDLV26CHOtherCAREFIRST BCBS
MDLV26CHOtherCAREFIRST BCBS
B94252Medicare UPIN