Provider Demographics
NPI:1245339829
Name:BUDUSKY, CHARLES KEVIN (DO)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:KEVIN
Last Name:BUDUSKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 CHARTER LN
Mailing Address - Street 2:SUITE 118
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6736
Mailing Address - Country:US
Mailing Address - Phone:717-290-6900
Mailing Address - Fax:717-290-1104
Practice Address - Street 1:1861 CHARTER LN
Practice Address - Street 2:SUITE 118
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6736
Practice Address - Country:US
Practice Address - Phone:717-290-6900
Practice Address - Fax:717-290-1104
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008066L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF79187Medicare UPIN