Provider Demographics
NPI:1194700062
Name:SITOMER, CHARLES I (M D)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:I
Last Name:SITOMER
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:21212 NORTHWEST FREEWAY
Mailing Address - Street 2:SUITE 365
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-5890
Mailing Address - Country:US
Mailing Address - Phone:832-237-5777
Mailing Address - Fax:832-237-5786
Practice Address - Street 1:21212 NORTHWEST FWY
Practice Address - Street 2:SUITE 365
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5884
Practice Address - Country:US
Practice Address - Phone:832-237-5777
Practice Address - Fax:832-237-5786
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG7341208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098397501Medicaid
TXB26490Medicare UPIN
TX00FQ77Medicare ID - Type Unspecified