Provider Demographics
NPI:1609969534
Name:LAMBIOTTE, CHARLES O (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:O
Last Name:LAMBIOTTE
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 1:141 E CORTLAND ST
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:NY
Mailing Address - Zip Code:13073-1107
Mailing Address - Country:US
Mailing Address - Phone:607-753-4811
Mailing Address - Fax:
Practice Address - Street 1:141 E CORTLAND ST
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:NY
Practice Address - Zip Code:13073-1107
Practice Address - Country:US
Practice Address - Phone:724-388-4607
Practice Address - Fax:814-938-6804
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055936L207P00000X, 207Q00000X
NY292448-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001714555Medicaid
PA080139699OtherRAILROAD MEDICARE
PALA029239OtherREFERRING
PA029239OtherBLUE SHIELD
PA1518464OtherGATEWAY
PALA029239OtherREFERRING
PA029239OtherBLUE SHIELD