Provider Demographics
NPI:1932182730
Name:CITRIN, CHARLES MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:MICHAEL
Last Name:CITRIN
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 1:7799 LEESBURG PIKE
Mailing Address - Street 2:SUITE 1000 N
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-2408
Mailing Address - Country:US
Mailing Address - Phone:703-667-8600
Mailing Address - Fax:703-667-8601
Practice Address - Street 1:3301 NEW MEXICO AVE NW
Practice Address - Street 2:SUITE 106
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-3622
Practice Address - Country:US
Practice Address - Phone:202-966-0606
Practice Address - Fax:202-244-6757
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD67832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
300135381OtherRR MEDICARE
MD054381100Medicaid
470001526OtherRR MEDICARE
MDFMX003Medicare PIN
MD575P178HMedicare PIN
C61797Medicare UPIN
MD054381100Medicaid
MD784M358FMedicare PIN
470001526OtherRR MEDICARE