Provider Demographics
NPI:1124276167
Name:CENTER FOR HEALTH OF CHARLOTTE PA
Entity type:Organization
Organization Name:CENTER FOR HEALTH OF CHARLOTTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:RUGGIERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-637-7000
Mailing Address - Street 1:1107 W MARION AVE
Mailing Address - Street 2:116
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-5372
Mailing Address - Country:US
Mailing Address - Phone:941-637-7000
Mailing Address - Fax:941-639-7576
Practice Address - Street 1:1107 W MARION AVE
Practice Address - Street 2:116
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-5372
Practice Address - Country:US
Practice Address - Phone:941-637-7000
Practice Address - Fax:941-639-7576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055973207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL97988OtherBCBS FL
FLAQ845Medicare PIN