Provider Demographics
NPI:1902397680
Name:CHARLES, AIDAN THURIAN (MD)
Entity type:Individual
Prefix:
First Name:AIDAN
Middle Name:THURIAN
Last Name:CHARLES
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 1:1431 SW FIRST AVENUE
Mailing Address - Street 2:
Mailing Address - City:OCALU
Mailing Address - State:FL
Mailing Address - Zip Code:34471
Mailing Address - Country:US
Mailing Address - Phone:352-401-1425
Mailing Address - Fax:
Practice Address - Street 1:1431 SW FIRST AVENUE
Practice Address - Street 2:
Practice Address - City:OCALU
Practice Address - State:FL
Practice Address - Zip Code:34471
Practice Address - Country:US
Practice Address - Phone:352-401-1425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program