Provider Demographics
NPI:1831189182
Name:MCCLUGGAGE, CHARLES W (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:MCCLUGGAGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 MUIRFIELD WAY
Mailing Address - Street 2:DEPT 808
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2963
Mailing Address - Country:US
Mailing Address - Phone:281-980-3577
Mailing Address - Fax:
Practice Address - Street 1:12951 SOUTH FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-1923
Practice Address - Country:US
Practice Address - Phone:713-526-5771
Practice Address - Fax:713-526-2036
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF78382085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136075203Medicaid
C19060Medicare UPIN
83R199Medicare ID - Type Unspecified