Provider Demographics
NPI:1639391741
Name:CHARLTON, GEORGE T (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:T
Last Name:CHARLTON
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:19 FRIENDSHIP ST
Mailing Address - Street 2:STE 260 BORDEN CARY BLDG
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2272
Mailing Address - Country:US
Mailing Address - Phone:401-845-1201
Mailing Address - Fax:401-845-1291
Practice Address - Street 1:19 FRIENDSHIP ST
Practice Address - Street 2:STE 260 BORDEN CARY BLDG
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2272
Practice Address - Country:US
Practice Address - Phone:401-845-1201
Practice Address - Fax:401-845-1291
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2014-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RI13666207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1639391741Medicaid
VA1639391741Medicaid