Provider Demographics
NPI:1831505379
Name:DUDA, CHARLES DAVID (DO)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:DAVID
Last Name:DUDA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:OH
Mailing Address - Zip Code:45828-1613
Mailing Address - Country:US
Mailing Address - Phone:419-678-2314
Mailing Address - Fax:
Practice Address - Street 1:950 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-2413
Practice Address - Country:US
Practice Address - Phone:419-586-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-04
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH012143208600000X
OH0070093208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery