Provider Demographics
NPI:1619160074
Name:CHARLSON, DONALD (DOM, L AC)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:CHARLSON
Suffix:
Gender:M
Credentials:DOM, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 US ROUTE 1 STE 2B
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9843
Mailing Address - Country:US
Mailing Address - Phone:207-515-2601
Mailing Address - Fax:207-910-5090
Practice Address - Street 1:383 US ROUTE 1 STE 2B
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9843
Practice Address - Country:US
Practice Address - Phone:207-515-2601
Practice Address - Fax:207-910-5090
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM567171100000X
MEAC 192171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist