MEDICARE: DR. MARC A CHARLES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	G40535	CA

General Provider Information

NPI Number	:	1316032386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC A CHARLES M.D.

Provider Business Mailing Address
First Line	:	1501 NORTH HARBOR BLVD
Second Line	:	203
City	:	FULLERTON
State	:	CA
Zip	:	92835-3811
Country	:	US
Telephone Number	:	714-871-5411
Fax Number	:	714-871-2401

Provider Business Practice Location Address
First Line	:	1501 NORTH HARBOR BLVD
Second Line	:	203
City	:	FULLERTON
State	:	CA
Zip	:	92835-3811
Country	:	US
Telephone Number	:	714-871-5411
Fax Number	:	714-871-2401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	12/12/2013

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