Healthcare Provider Details

I. General information

NPI: 1225024391
Provider Name (Legal Business Name): CHARLES AUSTIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 06/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629D LOWTHER RD SUITE 3950
LEWISBERRY PA
17339-9527
US

IV. Provider business mailing address

629D LOWTHER RD SUITE 3950
LEWISBERRY PA
17339-9527
US

V. Phone/Fax

Practice location:
  • Phone: 717-932-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD022195E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: