Provider Demographics
NPI:1932167558
Name:WOHL, CHARLES I (MD FACP)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:I
Last Name:WOHL
Suffix:
Gender:M
Credentials:MD FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201
Mailing Address - Country:US
Mailing Address - Phone:413-447-3028
Mailing Address - Fax:413-496-6836
Practice Address - Street 1:510 NORTH ST
Practice Address - Street 2:NEIGHBORHOOD HEALTH CENTER
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:413-447-2351
Practice Address - Fax:413-447-2355
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36611207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2031302Medicaid
MA2031302Medicaid
I22209Medicare ID - Type Unspecified