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General NPI Number Information
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NPI Number | 1346382652
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Entity Type | Individual
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Provider Name | CHARLES SARASOHN M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4121 DUTCHMANS LN SUITE 415
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City | LOUISVILLE
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State | KY
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Zip | 40207-4707
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Country | US
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Telephone | 502-893-5502
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Fax | 502-894-0836
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Provider Business Mailing Address
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Address Line | 6500 PRESTON HWY
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City | LOUISVILLE
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State | KY
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Zip | 40219-1820
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Country | US
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Telephone | 502-893-5502
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Fax | 502-721-8655
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 17044
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License Number State | KY
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