Provider Demographics
NPI:1003110685
Name:KING, CHARLES HARDING (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HARDING
Last Name:KING
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 1:3061 FAIRFAX RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-4057
Mailing Address - Country:US
Mailing Address - Phone:216-570-8135
Mailing Address - Fax:216-368-4825
Practice Address - Street 1:5550 VANTURE DRIVE
Practice Address - Street 2:CUYAHOGA COUNTY BOARD OF HEALTH
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-9315
Practice Address - Country:US
Practice Address - Phone:216-201-2041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047198207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease