Provider Demographics
NPI:1255336715
Name:DINERSTEIN, CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:DINERSTEIN
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:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-0300
Mailing Address - Country:US
Mailing Address - Phone:717-270-7780
Mailing Address - Fax:717-274-9746
Practice Address - Street 1:4TH & WALNUT STREETS
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-6123
Practice Address - Country:US
Practice Address - Phone:717-270-3751
Practice Address - Fax:270-270-3754
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0480882086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102760804001Medicaid
NJ3967000Medicaid
PA102760804001Medicaid
NJC58752Medicare UPIN
PA255295Medicare PIN