Provider Demographics
NPI:1912029117
Name:GAZOO, CHARLES (NP)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:GAZOO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3917
Mailing Address - Country:US
Mailing Address - Phone:540-829-4100
Mailing Address - Fax:540-829-5757
Practice Address - Street 1:501 SUNSET LN
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3917
Practice Address - Country:US
Practice Address - Phone:540-829-4100
Practice Address - Fax:540-829-5757
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001151059363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010053099Medicaid
VA500018174OtherRAILROAD MEDICARE
VA010053099Medicaid
VA500018174OtherRAILROAD MEDICARE
VAP30210Medicare UPIN