Provider Demographics
NPI:1245490937
Name:NG, CHARLOTTE (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:
Last Name:NG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9450 S SAGINAW RD STE E
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8206
Mailing Address - Country:US
Mailing Address - Phone:810-428-6227
Mailing Address - Fax:810-771-7410
Practice Address - Street 1:9450 S SAGINAW RD STE E
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8206
Practice Address - Country:US
Practice Address - Phone:810-428-6227
Practice Address - Fax:810-771-7410
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2018-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA39609207RC0000X
MI4301097235207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA410200008Medicare PIN
MIM34870041Medicare PIN