Provider Demographics
NPI:1386621282
Name:ALEX, CHARLES GEORGE (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:GEORGE
Last Name:ALEX
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:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1215 LEE ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-2600
Practice Address - Country:US
Practice Address - Phone:434-924-2409
Practice Address - Fax:434-982-4429
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063517207R00000X
IL36063517207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200825060BMedicaid
IL36063517Medicaid
IL36063517Medicaid
IL969780018Medicare PIN
IN200825060BMedicaid
IL776040Medicare PIN
ILF4002280626Medicare PIN
ILP01262605Medicare PIN