Provider Demographics
NPI:1417931940
Name:FAY, CHARLES PHILLIP (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:PHILLIP
Last Name:FAY
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:PSC 80 10502
Mailing Address - Street 2:APO AP 96367-0001
Mailing Address - City:KADENA AB
Mailing Address - State:OKINAWA
Mailing Address - Zip Code:96367
Mailing Address - Country:JP
Mailing Address - Phone:630-5558
Mailing Address - Fax:
Practice Address - Street 1:PSC 80 10502
Practice Address - Street 2:APO AP 96367-0001
Practice Address - City:KADENA AB
Practice Address - State:OKINAWA
Practice Address - Zip Code:96367
Practice Address - Country:JP
Practice Address - Phone:630-5558
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK55222083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine