Provider Demographics
NPI:1750329538
Name:HADDAD, CHARLES GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:GEORGE
Last Name:HADDAD
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 1:1033 US HIGHWAY 46
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2473
Mailing Address - Country:US
Mailing Address - Phone:973-779-7979
Mailing Address - Fax:973-779-7970
Practice Address - Street 1:1033 US HIGHWAY 46
Practice Address - Street 2:SUITE 102
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2473
Practice Address - Country:US
Practice Address - Phone:973-779-7979
Practice Address - Fax:973-779-7970
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07197100207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3725057OtherAETNA
NJP2744084OtherOXFORD HEALTHCARE
NJ62251OtherAMERIGROUP MEDICAID HMO
NJ6875X1OtherEMPIRE BCBS
NJ2333232000OtherAMERIHEALTH
NJ8682003Medicaid
NJ9400617OtherCIGNA
NJ1171476OtherHORIZON NJ HEALTH
NJ2333232000OtherAMERIHEALTH