Healthcare Provider Details

I. General information

NPI: 1982095485
Provider Name (Legal Business Name): CHARLES LAUDADIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 HARVEY LN
CHADDS FORD PA
19317-9728
US

IV. Provider business mailing address

116 HARVEY LN
CHADDS FORD PA
19317-9728
US

V. Phone/Fax

Practice location:
  • Phone: 610-459-1714
  • Fax:
Mailing address:
  • Phone: 610-459-1714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD045171L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC1-0002584
License Number StateDE

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: