Provider Demographics
NPI:1245298223
Name:NEWELL, CHARLES K (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:K
Last Name:NEWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2439 CARE DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4580
Mailing Address - Country:US
Mailing Address - Phone:850-942-6700
Mailing Address - Fax:850-942-5735
Practice Address - Street 1:2439 CARE DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4580
Practice Address - Country:US
Practice Address - Phone:850-942-6700
Practice Address - Fax:850-942-5735
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66977207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00825052AMedicaid
FL256551000Medicaid
G52158Medicare UPIN
GA18BDGRGMedicare PIN
FL46309XMedicare PIN