Provider Demographics
NPI:1881637759
Name:BARRETT, CHARLES VAN (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:VAN
Last Name:BARRETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 BOULEVARD ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2026
Mailing Address - Country:US
Mailing Address - Phone:330-602-0767
Mailing Address - Fax:330-365-3831
Practice Address - Street 1:844 BOULEVARD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2008
Practice Address - Country:US
Practice Address - Phone:330-473-6615
Practice Address - Fax:330-431-4352
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-005175207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0812535Medicaid
OHBA0773353Medicare ID - Type Unspecified
OHE75588Medicare UPIN