Provider Demographics
NPI:1891804068
Name:SPIRIDONIDIS, CHARALAMPOS A (MD)
Entity Type:Individual
Prefix:
First Name:CHARALAMPOS
Middle Name:A
Last Name:SPIRIDONIDIS
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 1:8100 RAVINES EDGE CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-5426
Mailing Address - Country:US
Mailing Address - Phone:614-846-0044
Mailing Address - Fax:614-846-3464
Practice Address - Street 1:8100 RAVINES EDGE CT
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-5426
Practice Address - Country:US
Practice Address - Phone:614-846-0044
Practice Address - Fax:614-846-3464
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050452174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0775602Medicaid
E07242Medicare UPIN
OH0775602Medicaid