Provider Demographics
NPI:1497728083
Name:DECARLI, CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:DECARLI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4860 Y ST
Mailing Address - Street 2:SUITE 3700
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-734-8413
Mailing Address - Fax:916-734-6526
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:SUITE 3700
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-8413
Practice Address - Fax:916-734-6526
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG859392084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE27308Medicare UPIN