Provider Demographics
NPI:1194288779
Name:CHARLES, DOROTHY N (MD)
Entity type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:N
Last Name:CHARLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2 TERMINAL DR STE 8
Mailing Address - Street 2:
Mailing Address - City:EAST ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62024-2294
Mailing Address - Country:US
Mailing Address - Phone:618-258-0485
Mailing Address - Fax:618-258-4815
Practice Address - Street 1:2 TERMINAL DR STE 8
Practice Address - Street 2:
Practice Address - City:EAST ALTON
Practice Address - State:IL
Practice Address - Zip Code:62024-2294
Practice Address - Country:US
Practice Address - Phone:618-258-0485
Practice Address - Fax:618-258-4815
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036161491207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine