Provider Demographics
NPI:1962544262
Name:ROUSELL, CHARLES H (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:H
Last Name:ROUSELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHARLES
Other - Middle Name:H
Other - Last Name:ROUSELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:38 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-4515
Mailing Address - Country:US
Mailing Address - Phone:203-661-9393
Mailing Address - Fax:203-661-9342
Practice Address - Street 1:38 LAKE AVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-4515
Practice Address - Country:US
Practice Address - Phone:203-661-9393
Practice Address - Fax:203-661-9342
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT0201432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry