Provider Demographics
NPI:1982602884
Name:RETHY, CHARLES ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ROBERT
Last Name:RETHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2416 WHITNEY AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3248
Mailing Address - Country:US
Mailing Address - Phone:203-248-4331
Mailing Address - Fax:203-248-7118
Practice Address - Street 1:2416 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3248
Practice Address - Country:US
Practice Address - Phone:203-248-4331
Practice Address - Fax:203-248-7118
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT019353207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0Q2054OtherHEALTHNET
CT110167932OtherRAILROAD MEDICARE
CT193530OtherCONNECTICARE
CTNHP062OtherOXFORD
CT010019353CT01OtherBLUE CROSS BLUE SHIELD
CT2047262OtherAETNA
CT0Q2054OtherHEALTHNET
CT110167932OtherRAILROAD MEDICARE