Provider Demographics
NPI:1467538413
Name:MOLDOW, CHARLES F (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:F
Last Name:MOLDOW
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 1:720 WASHINGTON AVE SE
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2924
Mailing Address - Country:US
Mailing Address - Phone:612-884-0999
Mailing Address - Fax:
Practice Address - Street 1:516 DELAWARE STREET S.E. CLINIC 3A
Practice Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-884-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21787207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
05G93MOOtherBLUE CROSS BLUE SHIELD
1017749OtherPREFERRED ONE
122987OtherUCARE
ND10387Medicaid
30-07017OtherMEDICA CHOICE
MT0051714Medicaid
IA0505529Medicaid
30-00009OtherMEDICA PRIMARY
HP28832OtherHEALTH PARTNERS
WI30211800Medicaid
778277OtherARAZ
SD7777470Medicaid
MN900321500Medicaid
WI30211800Medicaid
SD7777470Medicaid