MEDICARE: CHARLES E CULBERTSON MD

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	207R00000X	Internal Medicine Physician	137905	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110244049	OTHER	NY	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P010137905	OTHER	NY	BLUE CHOICE
3	00025581301	OTHER	NY	UNIVERA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	0414040	OTHER	NY	IHA
6	100855BJ	OTHER	NY	PREFERRED CARE
7	2342	OTHER	NY	SIDNEY HILLMAN
8	11122053	OTHER	NY	CAQH

General Provider Information

NPI Number	:	1922066729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES E CULBERTSON MD

Provider Business Mailing Address
First Line	:	4201 BUFFALO RD
Second Line	:	ATTN NANCY MOFFETT
City	:	NORTH CHILI
State	:	NY
Zip	:	14514-1201
Country	:	US
Telephone Number	:	585-594-5995
Fax Number	:	585-594-5425

Provider Business Practice Location Address
First Line	:	4201 BUFFALO RD
Second Line	:
City	:	NORTH CHILI
State	:	NY
Zip	:	14514-1201
Country	:	US
Telephone Number	:	585-594-5995
Fax Number	:	585-594-5425

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

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	08/21/2007

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Directions to “ CHARLES E CULBERTSON MD” Practice Location

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