Provider Demographics
NPI:1013924596
Name:SAROSY, CHARLES JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOHN
Last Name:SAROSY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8881 FLETCHER PARKWAY/ DR. CHARLES SAROSY
Mailing Address - Street 2:SUITE241
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942
Mailing Address - Country:US
Mailing Address - Phone:619-697-1325
Mailing Address - Fax:619-697-2981
Practice Address - Street 1:8881 FLETCHER PARKWAY/ DR. CHARLES SAROSY
Practice Address - Street 2:SUITE241
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942
Practice Address - Country:US
Practice Address - Phone:619-697-1325
Practice Address - Fax:619-697-2981
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG64236208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G642360Medicaid
CA00G642360Medicaid
CAG64236AMedicare PIN