Healthcare Provider Details

I. General information

NPI: 1508862491
Provider Name (Legal Business Name): SILAS J CHARLES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 S PINE ST
MELBOURNE FL
32901-3119
US

IV. Provider business mailing address

1815 VILLA ESPANA TRL
MELBOURNE FL
32935-4623
US

V. Phone/Fax

Practice location:
  • Phone: 321-952-0898
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0036401
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME36401
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: