Provider Demographics
NPI:1437167574
Name:DO, CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:DO
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 1:3000 Q ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-7058
Mailing Address - Country:US
Mailing Address - Phone:916-733-3333
Mailing Address - Fax:
Practice Address - Street 1:3000 Q ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7058
Practice Address - Country:US
Practice Address - Phone:916-733-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA372782085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A372780OtherBLUE SHIELD
CA1291919OtherGREAT WEST
CA36081OtherINTERPLAN
CA509520OtherFIRST HEALTH
CA5410051OtherAETNA
CAA37278OtherBLUE CROSS
CAMCMG168800OtherWESTERN HEALTH ADVANTAGE
CA00A372780Medicaid
CA6966655OtherCIGNA
CA820636OtherUNITED HEALTHCARE
CA90021916OtherPACIFICARE
CA000810342676OtherPHCS
CA047729OtherHEALTH NET
CA5410051OtherAETNA
CA00A372781Medicare ID - Type Unspecified