MEDICARE: DR. CHARLES PHILLIP FAY 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
1	2083A0100X	Aerospace Medicine Physician	K5522	TX

General Provider Information

NPI Number	:	1417931940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES PHILLIP FAY MD

Provider Business Mailing Address
First Line	:	PSC 80 10502
Second Line	:	APO AP 96367-0001
City	:	KADENA AB
State	:	OKINAWA
Zip	:	96367
Country	:	JP
Telephone Number	:	6305558
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 80 10502
Second Line	:	APO AP 96367-0001
City	:	KADENA AB
State	:	OKINAWA
Zip	:	96367
Country	:	JP
Telephone Number	:	6305558
Fax Number	:

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	07/21/2022

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