Provider Demographics
NPI:1710901012
Name:CASE, CHARLES G (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:G
Last Name:CASE
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 1:601 NEW CASTLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-5821
Mailing Address - Country:US
Mailing Address - Phone:302-427-9694
Mailing Address - Fax:302-655-6606
Practice Address - Street 1:601 NEW CASTLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-5821
Practice Address - Country:US
Practice Address - Phone:302-655-6187
Practice Address - Fax:302-655-6606
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0003567207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE703E04OtherBLUE CROSS BLUE SHIELD
DE0000328401Medicaid
DE0473654000OtherAMERIHEALTH
DE4410537OtherAETNA
DE46217OtherCOVENTRY
DE0000328401Medicaid
DE46217OtherCOVENTRY