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General NPI Number Information
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NPI Number | 1972914935
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Entity Type | Individual
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Provider Name | CHARLES LIM PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/13/2014
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Last Update Date | 12/17/2014
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Provider Practice Location Address
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Address Line | 601 N CAROLINE ST SUITE 5214
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City | BALTIMORE
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State | MD
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Zip | 21287-0006
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Country | US
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Telephone | 410-955-1830
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Fax |
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Provider Business Mailing Address
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Address Line | 601 N CAROLINE ST SUITE 5214
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City | BALTIMORE
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State | MD
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Zip | 21287-0006
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Country | US
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Telephone | 917-705-3034
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA056843
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00335400
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C05403
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License Number State | MD
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