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General NPI Number Information
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NPI Number | 1790852416
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Entity Type | Individual
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Provider Name | CHARLES ROBERT OLAF D.O.
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Gender | Male
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 3037 S PIKE AVE
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City | ALLENTOWN
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State | PA
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Zip | 18103-7650
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Country | US
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Telephone | 610-797-1220
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Fax | 610-797-8060
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Provider Business Mailing Address
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Address Line | 3037 S PIKE AVE
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City | ALLENTOWN
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State | PA
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Zip | 18103-7650
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Country | US
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Telephone | 610-797-1220
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Fax | 610-797-8060
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | OS002720L
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License Number State | PA
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