Provider Demographics
NPI:1457344335
Name:NAGEL, CHARLOTTE (MD)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:NAGEL
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 1:1955 MONUMENT BLVD
Mailing Address - Street 2:#A
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-3873
Mailing Address - Country:US
Mailing Address - Phone:925-689-1800
Mailing Address - Fax:
Practice Address - Street 1:1955 MONUMENT BLVD
Practice Address - Street 2:#A
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-3873
Practice Address - Country:US
Practice Address - Phone:925-689-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51683207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A516830Medicaid
CA00A516830Medicaid
CAP00163280Medicare PIN