Provider Demographics
NPI:1619076379
Name:MARDER, CHARLES B (DPM)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:B
Last Name:MARDER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 W PARKER RD STE 420
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8134
Mailing Address - Country:US
Mailing Address - Phone:972-981-7900
Mailing Address - Fax:972-981-7781
Practice Address - Street 1:6300 W PARKER RD STE 420
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8134
Practice Address - Country:US
Practice Address - Phone:972-981-7900
Practice Address - Fax:972-981-7781
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDP1106213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097906404Medicaid
TX097906403Medicaid
TX8K5580Medicare PIN
TXU13254Medicare UPIN
TX097906404Medicaid