Provider Demographics
NPI:1588660229
Name:LALONDE, CHARLES J (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:LALONDE
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 1:175 S UNION BLVD
Mailing Address - Street 2:STE 220
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3147
Mailing Address - Country:US
Mailing Address - Phone:719-634-1532
Mailing Address - Fax:719-634-1715
Practice Address - Street 1:175 S UNION BLVD
Practice Address - Street 2:STE 220
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3147
Practice Address - Country:US
Practice Address - Phone:719-634-1532
Practice Address - Fax:719-634-1715
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34378207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01343789Medicaid
COG10794Medicare UPIN
CO01343789Medicaid