Provider Demographics
NPI:1730304312
Name:OLSEN, CHARLES THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:THOMAS
Last Name:OLSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10013 SORREL AVE
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4748
Mailing Address - Country:US
Mailing Address - Phone:301-299-0401
Mailing Address - Fax:301-299-0401
Practice Address - Street 1:10013 SORREL AVE
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-4748
Practice Address - Country:US
Practice Address - Phone:301-299-0401
Practice Address - Fax:301-299-0401
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2016-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00029502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
C61963Medicare UPIN
028377Medicare ID - Type Unspecified