Provider Demographics
NPI:1982663605
Name:TADROS, CHARLES H (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:H
Last Name:TADROS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9701 LANDMARK PARKWAY DR STE 110
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1665
Mailing Address - Country:US
Mailing Address - Phone:314-270-4247
Mailing Address - Fax:314-270-4248
Practice Address - Street 1:9701 LANDMARK PARKWAY DR STE 110
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1665
Practice Address - Country:US
Practice Address - Phone:314-270-4247
Practice Address - Fax:314-270-4248
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR7P58207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA4454001Medicare PIN
F71285Medicare UPIN