Provider Demographics
NPI:1790781839
Name:ZACKS, CHARLES M (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:M
Last Name:ZACKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:15 LOWELL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2748
Mailing Address - Country:US
Mailing Address - Phone:207-774-8277
Mailing Address - Fax:207-699-5850
Practice Address - Street 1:15 LOWELL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2748
Practice Address - Country:US
Practice Address - Phone:207-774-8277
Practice Address - Fax:207-699-5850
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME012866207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME306880099Medicare ID - Type Unspecified
MEMM3079Medicare UPIN
MEE69103Medicare UPIN