Provider Demographics
NPI:1841201399
Name:ODGERS, CHARLES J (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:ODGERS
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 1:266 LANCASTER AVE.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355
Mailing Address - Country:US
Mailing Address - Phone:610-644-6900
Mailing Address - Fax:610-644-7160
Practice Address - Street 1:266 LANCASTER AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3256
Practice Address - Country:US
Practice Address - Phone:610-644-6900
Practice Address - Fax:610-644-7160
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD053993L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH32931Medicare UPIN
PA081833J6DMedicare ID - Type Unspecified
PA034967Medicare PIN