Provider Demographics
NPI:1285785683
Name:OATES, CHARLES EDWIN (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDWIN
Last Name:OATES
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 1:6801 DIXIE HWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3913
Mailing Address - Country:US
Mailing Address - Phone:502-451-5855
Mailing Address - Fax:502-479-1409
Practice Address - Street 1:6400 DUTCHMANS PKWY
Practice Address - Street 2:SUITE 145
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3340
Practice Address - Country:US
Practice Address - Phone:502-895-2902
Practice Address - Fax:502-893-8867
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY214692084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64214695Medicaid
KYP00398499OtherRR MEDICARE
KY00213002Medicare PIN
KYP00398499OtherRR MEDICARE