Provider Demographics
NPI:1891972899
Name:OLADELL, CHARMAINE KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARMAINE
Middle Name:KAY
Last Name:OLADELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHARMAINE
Other - Middle Name:KAY
Other - Last Name:MOCZYGEMBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:505 OMEGA DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2004
Mailing Address - Country:US
Mailing Address - Phone:817-468-3255
Mailing Address - Fax:817-468-7823
Practice Address - Street 1:505 OMEGA DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2004
Practice Address - Country:US
Practice Address - Phone:817-468-3255
Practice Address - Fax:817-468-7823
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2194207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211750901Medicaid
TXN2194OtherSTATE MEDICAL LICENSE
TX211750901Medicaid