Provider Demographics
NPI:1629032925
Name:EGER, CHARLES H (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:H
Last Name:EGER
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 1:1507 SPRINGFIELD PIKE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215
Mailing Address - Country:US
Mailing Address - Phone:513-821-3700
Mailing Address - Fax:513-821-4333
Practice Address - Street 1:1507 SPRINGFIELD PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215
Practice Address - Country:US
Practice Address - Phone:513-821-3700
Practice Address - Fax:513-821-4333
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050671E207R00000X
OH35-050671207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100011590Medicaid
OH0626111Medicaid
KY64787633Medicaid
OH0584169Medicare PIN
OH0626111Medicaid
A16470Medicare UPIN
OHA16470Medicare UPIN