Provider Demographics
NPI:1215966098
Name:CATTANO, CHARLES J (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:CATTANO
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 1:1017 STONINGTON DR
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-1659
Mailing Address - Country:US
Mailing Address - Phone:410-353-3374
Mailing Address - Fax:410-349-3447
Practice Address - Street 1:1017 STONINGTON DR
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-1659
Practice Address - Country:US
Practice Address - Phone:410-353-3374
Practice Address - Fax:410-349-3447
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD22644207RG0100X
MDMD46972207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD699544600Medicaid
MDH425D326Medicare PIN
MDB36649Medicare UPIN