Provider Demographics
NPI:1922442672
Name:GANLEY, CHARLES JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JAMES
Last Name:GANLEY
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 1:2 CAMBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-1607
Mailing Address - Country:US
Mailing Address - Phone:410-268-9017
Mailing Address - Fax:
Practice Address - Street 1:2 CAMBRIDGE CT
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-1607
Practice Address - Country:US
Practice Address - Phone:410-268-9017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0041029207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine