Provider Demographics
NPI:1831172733
Name:JOSLIN, CHARLIE G (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLIE
Middle Name:G
Last Name:JOSLIN
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 1:300 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ELLINWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:67526-1452
Mailing Address - Country:US
Mailing Address - Phone:620-564-2548
Mailing Address - Fax:620-564-2491
Practice Address - Street 1:300 N PARK AVE
Practice Address - Street 2:
Practice Address - City:ELLINWOOD
Practice Address - State:KS
Practice Address - Zip Code:67526-1452
Practice Address - Country:US
Practice Address - Phone:620-564-2548
Practice Address - Fax:620-564-2684
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0422818207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100123620DMedicaid
KS110746OtherGROUP RHC
KS173402OtherGROUP RHC
KS173402OtherGROUP RHC
KS110746OtherGROUP RHC