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NPI Code Detail

MEDICARE: ERNEST CHARLESWORTH MD

MEDICARE: ERNEST CHARLESWORTH MD
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
1207N00000XDermatology PhysicianD8172TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114921459
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERNEST CHARLESWORTH MD
Provider Business Mailing Address
First Line : PO BOX 22000
Second Line :
City : SAN ANGELO
State : TX
Zip : 76902-7200
Country : US
Telephone Number : 325-481-2294
Fax Number :
Provider Business Practice Location Address
First Line : 120 E BEAUREGARD AVE
Second Line :
City : SAN ANGELO
State : TX
Zip : 76903-5919
Country : US
Telephone Number : 325-481-2294
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 01/16/2013

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