Provider Demographics
NPI:1255525754
Name:PHILIP, CHARLES (DO)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:PHILIP
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 1:345 N MAIN ST FL 1
Mailing Address - Street 2:APT
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2515
Mailing Address - Country:US
Mailing Address - Phone:860-547-1489
Mailing Address - Fax:
Practice Address - Street 1:345 N MAIN ST FL 1
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2515
Practice Address - Country:US
Practice Address - Phone:860-547-1489
Practice Address - Fax:860-548-9105
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT053621207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease