Provider Demographics
NPI:1619160074
Name:CHARLSON, DONALD (DOM, L AC)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:CHARLSON
Suffix:
Gender:M
Credentials:DOM, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 FOX RUN CT
Mailing Address - Street 2:
Mailing Address - City:WINTERPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04496-3045
Mailing Address - Country:US
Mailing Address - Phone:207-701-1193
Mailing Address - Fax:
Practice Address - Street 1:12 FOX RUN CT
Practice Address - Street 2:
Practice Address - City:WINTERPORT
Practice Address - State:ME
Practice Address - Zip Code:04496-3045
Practice Address - Country:US
Practice Address - Phone:207-701-1193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM567171100000X
MEAC 192171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist