Provider Demographics
NPI:1598726838
Name:CHARLES, MARCELIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCELIN
Middle Name:
Last Name:CHARLES
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 1:1840 CASCADIA CIR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-3687
Mailing Address - Country:US
Mailing Address - Phone:541-245-1378
Mailing Address - Fax:
Practice Address - Street 1:691 MURPHY RD
Practice Address - Street 2:SUITE 107
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4346
Practice Address - Country:US
Practice Address - Phone:541-789-6460
Practice Address - Fax:541-789-6461
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26819207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR240547Medicaid
ORR134930Medicare PIN
OR240547Medicaid