Healthcare Provider Details

I. General information

NPI: 1780697029
Provider Name (Legal Business Name): CHARLES ALAN SHOLITON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 CONGRESS PARK DR
DAYTON OH
45459-4133
US

IV. Provider business mailing address

7619 S GOODRICH SQ
NEW ALBANY OH
43054-8931
US

V. Phone/Fax

Practice location:
  • Phone: 937-312-3658
  • Fax: 937-312-3719
Mailing address:
  • Phone: 614-264-2038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number35-040866
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: