Provider Demographics
NPI:1619959657
Name:CHODOROW, CHARLES H (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:H
Last Name:CHODOROW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 144333
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-4333
Mailing Address - Country:US
Mailing Address - Phone:407-422-9831
Mailing Address - Fax:407-648-2065
Practice Address - Street 1:1350 S HICKORY ST
Practice Address - Street 2:DEPT. OF PATHOLOGY
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3278
Practice Address - Country:US
Practice Address - Phone:321-434-7000
Practice Address - Fax:321-434-5295
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6659207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377015000Medicaid
FL80896VOtherMEDICARE - HF
220021943Medicare PIN
F81876Medicare UPIN
FL80896ZMedicare PIN