Provider Demographics
NPI:1407956691
Name:CONLON, CHARLES L (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:L
Last Name:CONLON
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 1:16675 SOUTHWEST FWY
Mailing Address - Street 2:#200
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2344
Mailing Address - Country:US
Mailing Address - Phone:281-265-5454
Mailing Address - Fax:281-265-5484
Practice Address - Street 1:16675 SOUTHWEST FWY
Practice Address - Street 2:#200
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2344
Practice Address - Country:US
Practice Address - Phone:281-265-5454
Practice Address - Fax:281-265-5484
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE4266207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135300508Medicaid
B21958Medicare UPIN
TX00614MMedicare ID - Type Unspecified