Healthcare Provider Details

I. General information

NPI: 1194288779
Provider Name (Legal Business Name): DOROTHY N CHARLES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3396 PERSHALL RD
FERGUSON MO
63135-1407
US

IV. Provider business mailing address

3396 PERSHALL RD
FERGUSON MO
63135-1407
US

V. Phone/Fax

Practice location:
  • Phone: 314-814-8700
  • Fax: 314-814-8589
Mailing address:
  • Phone: 314-814-8700
  • Fax: 314-814-8589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2025032016
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036161491
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: