Provider Demographics
NPI:1104250570
Name:CHAULK, CHARLES PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:PATRICK
Last Name:CHAULK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:622 VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-7311
Mailing Address - Country:US
Mailing Address - Phone:410-828-8831
Mailing Address - Fax:410-396-8457
Practice Address - Street 1:622 VALLEY LN
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-7311
Practice Address - Country:US
Practice Address - Phone:410-828-8831
Practice Address - Fax:410-396-8457
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD371792083P0901X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics