MEDICARE: DR. CHARLES R ZIPKIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	00A237470	CA

General Provider Information

NPI Number	:	1063418309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES R ZIPKIN M.D.

Provider Business Mailing Address
First Line	:	10833 DONNER PASS RD
Second Line	:	STE 101
City	:	TRUCKEE
State	:	CA
Zip	:	96161-4851
Country	:	US
Telephone Number	:	530-587-7208
Fax Number	:	530-587-7208

Provider Business Practice Location Address
First Line	:	10833 DONNER PASS RD
Second Line	:	STE101
City	:	TRUCKEE
State	:	CA
Zip	:	96161-4851
Country	:	US
Telephone Number	:	530-587-7208
Fax Number	:	530-587-7208

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/08/2007

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