Provider Demographics
NPI:1508937467
Name:ODOWD, CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:ODOWD
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 1:200 E ECKERSON RD
Mailing Address - Street 2:STE 1-6
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-7153
Mailing Address - Country:US
Mailing Address - Phone:845-352-5900
Mailing Address - Fax:845-352-1142
Practice Address - Street 1:200 E ECKERSON RD
Practice Address - Street 2:STE 1-6
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-7153
Practice Address - Country:US
Practice Address - Phone:845-352-5900
Practice Address - Fax:845-352-1142
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1793841207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY88F431Medicare PIN
CN2457Medicare PIN
E89276Medicare UPIN