Provider Demographics
NPI:1508837402
Name:ZELEN, CHARLES M (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:M
Last Name:ZELEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 WALNUT AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4723
Mailing Address - Country:US
Mailing Address - Phone:540-344-3668
Mailing Address - Fax:540-769-6381
Practice Address - Street 1:222 WALNUT AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4723
Practice Address - Country:US
Practice Address - Phone:540-344-3668
Practice Address - Fax:540-769-6381
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103001015213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0102774000Medicaid
VA5715980001Medicare NSC
VA0102774000Medicaid
VAP00323199Medicare PIN
VA00X063F01Medicare PIN