Healthcare Provider Details

I. General information

NPI: 1477592335
Provider Name (Legal Business Name): CHARLES J BAE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3624 MARKET ST STE 201
PHILADELPHIA PA
19104-2614
US

IV. Provider business mailing address

3624 MARKET ST STE 201
PHILADELPHIA PA
19104-2614
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-7772
  • Fax:
Mailing address:
  • Phone: 215-662-7772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberMD461584
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberMD461584
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: