Healthcare Provider Details

I. General information

NPI: 1821034059
Provider Name (Legal Business Name): CHARLES W SCHWAB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE STREET 2 DULLES
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

3400 SPRUCE STREET 2 DULLES
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-7320
  • Fax: 215-243-4605
Mailing address:
  • Phone: 215-662-7320
  • Fax: 215-243-4605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD038757E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMD038757E
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD038757E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: