Provider Demographics
NPI:1245213024
Name:OH, CHARLES I (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:I
Last Name:OH
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 1:4601 IRONBOUND RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2648
Mailing Address - Country:US
Mailing Address - Phone:757-253-5161
Mailing Address - Fax:
Practice Address - Street 1:4601 IRONBOUND RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2648
Practice Address - Country:US
Practice Address - Phone:757-253-5161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101222286207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C30131Medicare ID - Type Unspecified
F05185Medicare UPIN