Provider Demographics
NPI:1063418309
Name:ZIPKIN, CHARLES R (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:ZIPKIN
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 1:10833 DONNER PASS RD
Mailing Address - Street 2:STE 101
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-4851
Mailing Address - Country:US
Mailing Address - Phone:530-587-7208
Mailing Address - Fax:530-587-7208
Practice Address - Street 1:10833 DONNER PASS RD
Practice Address - Street 2:STE101
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4851
Practice Address - Country:US
Practice Address - Phone:530-587-7208
Practice Address - Fax:530-587-7208
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A237470174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY49120YMedicare ID - Type Unspecified
CAA23667Medicare UPIN