Provider Demographics
NPI:1881689834
Name:WARE, CHARLES MCDONALD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MCDONALD
Last Name:WARE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:270 E DAY RD
Mailing Address - Street 2:STE 200
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3444
Mailing Address - Country:US
Mailing Address - Phone:574-271-5151
Mailing Address - Fax:574-271-5175
Practice Address - Street 1:270 E DAY RD
Practice Address - Street 2:STE 200
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3444
Practice Address - Country:US
Practice Address - Phone:574-271-5151
Practice Address - Fax:574-271-5175
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2008-05-08
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Provider Licenses
StateLicense IDTaxonomies
IN01041995207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA200028305OtherRR MEDICARE
IN100409920Medicaid
000000092064OtherBC/BS (ANTHEM)
IN131980AMedicare PIN
GA200028305OtherRR MEDICARE
IN100409920Medicaid