Provider Demographics
NPI:1770751638
Name:CHARLES E. OATES MD PLLC
Entity type:Organization
Organization Name:CHARLES E. OATES MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:OATES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-897-5997
Mailing Address - Street 1:4002 KRESGE WAY
Mailing Address - Street 2:SUITE 124
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4605
Mailing Address - Country:US
Mailing Address - Phone:502-897-5997
Mailing Address - Fax:502-897-5998
Practice Address - Street 1:4002 KRESGE WAY
Practice Address - Street 2:SUITE 124
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4605
Practice Address - Country:US
Practice Address - Phone:502-897-5997
Practice Address - Fax:502-897-5998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty