Provider Demographics
NPI:1881601946
Name:HABELOW, CHARLES RAYMOND (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RAYMOND
Last Name:HABELOW
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:PO BOX 510310
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33951-0310
Mailing Address - Country:US
Mailing Address - Phone:863-494-2293
Mailing Address - Fax:863-494-1520
Practice Address - Street 1:301 N BREVARD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-4501
Practice Address - Country:US
Practice Address - Phone:863-494-2293
Practice Address - Fax:863-494-1520
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0049217207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046638701Medicaid
FL1508029349OtherTYPE II NPI
FLDN9810OtherRAILROAD MEDICARE PTAN
FL1881601946OtherNPI, TYPE I
FL04349ZMedicare PIN
FL1508029349OtherTYPE II NPI
FL046638701Medicaid