Provider Demographics
NPI:1710909643
Name:CHARLES F. TUFFLI JR M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CHARLES F. TUFFLI JR M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:TUFFLI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:408-286-6900
Mailing Address - Street 1:2100 FOREST AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1422
Mailing Address - Country:US
Mailing Address - Phone:408-286-6900
Mailing Address - Fax:408-286-6917
Practice Address - Street 1:2100 FOREST AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1422
Practice Address - Country:US
Practice Address - Phone:408-286-6900
Practice Address - Fax:408-286-6917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG021128207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G211280OtherMEDICARE PROVIDER ID
A41190Medicare UPIN