Provider Demographics
NPI:1578691457
Name:DRUFFNER, CHARLES RICHARD (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:RICHARD
Last Name:DRUFFNER
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 1:1851 NEWTON RANSOM BLVD
Mailing Address - Street 2:APT #2
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9691
Mailing Address - Country:US
Mailing Address - Phone:570-587-4344
Mailing Address - Fax:
Practice Address - Street 1:1851 NEWTON RANSOM BLVD
Practice Address - Street 2:APT#2
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-9691
Practice Address - Country:US
Practice Address - Phone:570-587-4344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027676L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0953596Medicaid
PA0953596Medicaid
32201Medicare ID - Type Unspecified