Provider Demographics
NPI:1750672978
Name:CHARLES KARESH NURSING HOME SERVICE
Entity Type:Organization
Organization Name:CHARLES KARESH NURSING HOME SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:KARESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-949-4886
Mailing Address - Street 1:12154 DARNESTOWN RD
Mailing Address - Street 2:STE 625
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2206
Mailing Address - Country:US
Mailing Address - Phone:240-949-4886
Mailing Address - Fax:240-252-5752
Practice Address - Street 1:9701 VEIRS DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3414
Practice Address - Country:US
Practice Address - Phone:301-482-0130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0021726207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC118096Medicare PIN
MDC61942Medicare UPIN