Provider Demographics
NPI:1952628729
Name:CHARLES F. COLAO,M.D.,P.A.
Entity Type:Organization
Organization Name:CHARLES F. COLAO,M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:COLAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-899-1320
Mailing Address - Street 1:3710 RIVIERA ST
Mailing Address - Street 2:SUIRTE 2D
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-1719
Mailing Address - Country:US
Mailing Address - Phone:301-899-1320
Mailing Address - Fax:301-899-5107
Practice Address - Street 1:3710 RIVIERA ST
Practice Address - Street 2:SUIRTE 2D
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1719
Practice Address - Country:US
Practice Address - Phone:301-899-1320
Practice Address - Fax:301-899-5107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC010588600Medicaid
MD345021000Medicaid
C62245Medicare UPIN