Provider Demographics
NPI:1427103472
Name:TOLEDO, CHARLES H (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:H
Last Name:TOLEDO
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 1:1750 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2195
Mailing Address - Country:US
Mailing Address - Phone:541-269-0333
Mailing Address - Fax:541-269-7389
Practice Address - Street 1:1750 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2100
Practice Address - Country:US
Practice Address - Phone:541-269-0333
Practice Address - Fax:541-269-7389
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31398208000000X
ORMD189415208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500752265Medicaid
NC6983577Medicaid
NC6983577Medicaid