Provider Demographics
NPI:1396759635
Name:SACKMANN, CHARLES MARTIN (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:MARTIN
Last Name:SACKMANN
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:P.O. BOX 438
Mailing Address - Street 2:
Mailing Address - City:RITZVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99169-0438
Mailing Address - Country:US
Mailing Address - Phone:509-659-4800
Mailing Address - Fax:509-659-4801
Practice Address - Street 1:210 W. MAIN
Practice Address - Street 2:
Practice Address - City:RITZVILLE
Practice Address - State:WA
Practice Address - Zip Code:99169-0438
Practice Address - Country:US
Practice Address - Phone:509-659-4800
Practice Address - Fax:509-659-4801
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027448207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0050906OtherWA L&I
WA8119547Medicaid
00356504Medicare UPIN
WA0050906OtherWA L&I
WAE72454Medicare UPIN