Provider Demographics
NPI:1841291945
Name:NOBLE, CHARLES W II (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:NOBLE
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:5825 WESTBOURNE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1459
Mailing Address - Country:US
Mailing Address - Phone:614-464-0884
Mailing Address - Fax:614-464-3440
Practice Address - Street 1:5825 WESTBOURNE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1459
Practice Address - Country:US
Practice Address - Phone:614-464-0884
Practice Address - Fax:614-464-3440
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062851207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0879241Medicaid
OHF10659Medicare UPIN
OH0879241Medicaid
OHF10659Medicare UPIN
OHNO4182049Medicare PIN