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NPI Code Detail

MEDICARE: DR. CHARLES F. ORMISTON M.D.

MEDICARE: DR. CHARLES F. ORMISTON 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
12084N0400XNeurology Physician271787MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629060496
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES F. ORMISTON M.D.
Provider Business Mailing Address
First Line : 1650 BEAM AVE
Second Line : SUITE 200
City : MAPLEWOOD
State : MN
Zip : 55109-1192
Country : US
Telephone Number : 651-221-9051
Fax Number : 651-223-5220
Provider Business Practice Location Address
First Line : 1650 BEAM AVE
Second Line : SUITE 200
City : MAPLEWOOD
State : MN
Zip : 55109-1192
Country : US
Telephone Number : 651-221-9051
Fax Number : 651-223-5220
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2005
Last Update Date : 01/05/2011

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