Healthcare Provider Details

I. General information

NPI: 1891891735
Provider Name (Legal Business Name): CHARLES A MCLAUGHLIN JR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 W DR MARTIN LUTHER KING JR BLVD SUITE 510
TAMPA FL
33607-6383
US

IV. Provider business mailing address

2727 W DR MARTIN LUTHER KING JR BLVD SUITE 510
TAMPA FL
33607-6383
US

V. Phone/Fax

Practice location:
  • Phone: 813-879-8358
  • Fax: 813-875-9018
Mailing address:
  • Phone: 813-879-8358
  • Fax: 813-875-9018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME0030751
License Number StateFL

VIII. Authorized Official

Name: DR. CHARLES ALLEN MCLAUGHLIN JR.
Title or Position: PROPRIETOR
Credential: MD
Phone: 813-879-8358