Provider Demographics
NPI:1932286523
Name:PAPPAS, CHARLES NICHOLAS (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:NICHOLAS
Last Name:PAPPAS
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 1:609 STOCKBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:VT
Mailing Address - Zip Code:05445-9361
Mailing Address - Country:US
Mailing Address - Phone:802-238-6041
Mailing Address - Fax:802-425-5223
Practice Address - Street 1:609 STOCKBRIDGE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:VT
Practice Address - Zip Code:05445-9361
Practice Address - Country:US
Practice Address - Phone:802-238-6041
Practice Address - Fax:802-425-5223
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT04200089612085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTF61715Medicare UPIN
VTVN0936Medicare ID - Type Unspecified
VTOVN0936Medicaid
VT00019885OtherBLUE SHIELD