Healthcare Provider Details

I. General information

NPI: 1467480848
Provider Name (Legal Business Name): CHARLES H CHODROFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3065 WINDSOR RD
RED LION PA
17356-8533
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-851-1700
  • Fax: 717-851-1710
Mailing address:
  • Phone: 717-851-1700
  • Fax: 717-851-1710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD028272E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD028272E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: