Provider Demographics
NPI:1457493710
Name:CHARLES CHALEKSON, MD INC
Entity Type:Organization
Organization Name:CHARLES CHALEKSON, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALEKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-434-2828
Mailing Address - Street 1:1310 LAS TABLAS RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9737
Mailing Address - Country:US
Mailing Address - Phone:805-434-2828
Mailing Address - Fax:805-434-9928
Practice Address - Street 1:1310 LAS TABLAS RD
Practice Address - Street 2:SUITE 202
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9737
Practice Address - Country:US
Practice Address - Phone:805-434-2828
Practice Address - Fax:805-434-9928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA777822086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1770668642OtherNPI-INDIVIDUAL
CAH60938Medicare UPIN
CA1770668642OtherNPI-INDIVIDUAL