Provider Demographics
NPI:1487835179
Name:CHARLES, DAVID ANTHONY (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ANTHONY
Last Name:CHARLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:15200 SHADY GROVE RD
Mailing Address - Street 2:STE. 307
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3218
Mailing Address - Country:US
Mailing Address - Phone:301-738-8846
Mailing Address - Fax:301-762-8625
Practice Address - Street 1:15200 SHADY GROVE RD
Practice Address - Street 2:STE. 307
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3218
Practice Address - Country:US
Practice Address - Phone:301-738-8846
Practice Address - Fax:301-762-8625
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0054843207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD490547Medicare PIN
MDH11599Medicare UPIN