Provider Demographics
NPI:1639168438
Name:BERUL, CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:BERUL
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 1:111 MICHIGAN AVE, NW
Mailing Address - Street 2:CHILDREN'S NATIONAL MEDICAL CENTER
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010
Mailing Address - Country:US
Mailing Address - Phone:202-476-5710
Mailing Address - Fax:202-476-5700
Practice Address - Street 1:111 MICHIGAN AVE, NW
Practice Address - Street 2:CHILDREN'S NATIONAL MEDICAL CENTER
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010
Practice Address - Country:US
Practice Address - Phone:202-476-5710
Practice Address - Fax:202-476-5700
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA794762080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA98980501OtherNETWORK HEALTH
RICB27007Medicaid
MAJ30667OtherBCBS MA
MAAA9204OtherHARVARD PILGRIM
CT003110939Medicaid
NY2201921Medicaid
NH30007203Medicaid
NJ8753601Medicaid
MA7500305OtherUNITED HEALTHCARE MA
MAB20471601OtherCIGNA MA
MA3183467Medicaid
MAA28402Medicare ID - Type Unspecified
NY2201921Medicaid