Provider Demographics
NPI:1740448489
Name:JANSSENS, CHARLES M (DO)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:M
Last Name:JANSSENS
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E COUNTY LINE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1070
Mailing Address - Country:US
Mailing Address - Phone:317-885-2860
Mailing Address - Fax:317-885-2869
Practice Address - Street 1:68 ROUTE 16B
Practice Address - Street 2:
Practice Address - City:CTR OSSIPEE
Practice Address - State:NH
Practice Address - Zip Code:03814-6850
Practice Address - Country:US
Practice Address - Phone:603-651-1441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU7119207R00000X
AL3445207R00000X
IN02003428A207R00000X, 208M00000X
OH34.011017207R00000X
PAOS024267207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0107618Medicaid
IN300020018Medicaid
OHH360841Medicare PIN
OH0107618Medicaid