Provider Demographics
NPI:1962443945
Name:KNOLL, CHARLES I (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:I
Last Name:KNOLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:ANNENBERG 2 WEST
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-834-7870
Mailing Address - Fax:760-834-7871
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:ANNENBERG 2 WEST
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-834-7870
Practice Address - Fax:760-834-7871
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD27724208100000X
CAA100046208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403418000Medicaid
MDKR82G818Medicare ID - Type Unspecified
MD403418000Medicaid