Provider Demographics
NPI:1881865277
Name:DOSS, CHARLES RICHARD
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:RICHARD
Last Name:DOSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 POTTS HILL RD
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:45612-9765
Mailing Address - Country:US
Mailing Address - Phone:740-634-3501
Mailing Address - Fax:740-634-3502
Practice Address - Street 1:1535 POTTS HILL RD
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:45612-9765
Practice Address - Country:US
Practice Address - Phone:740-634-3501
Practice Address - Fax:740-634-3502
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2250451Medicaid
OH7100363Medicaid