Provider Demographics
NPI:1689663288
Name:GARGANO, CHARLES ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ANTHONY
Last Name:GARGANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5096
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98227-5096
Mailing Address - Country:US
Mailing Address - Phone:360-738-2200
Mailing Address - Fax:360-752-5682
Practice Address - Street 1:4545 CORDATA PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-7123
Practice Address - Country:US
Practice Address - Phone:360-738-2200
Practice Address - Fax:360-752-5682
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042376207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1689663288Medicaid
WA4446GAOtherREGENCE
WA8361537Medicaid
WA0229843OtherL&I AND CRIME VICTIMS
WA7830444OtherAETNA
WAH90115Medicare UPIN
WAG8871848Medicare PIN