Basic Information
Provider Information | |||||||||
NPI: | 1134101298 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ABRAHAMSEN | ||||||||
FirstName: | CHARLES | ||||||||
MiddleName: | ERNST | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 10000 BAY PINES BLVD. (SURGICAL SERVICES 112) | ||||||||
Address2: | BAY PINES VAHCS | ||||||||
City: | BAY PINES | ||||||||
State: | FL | ||||||||
PostalCode: | 33744 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7273986661 | ||||||||
FaxNumber: | 7273191332 | ||||||||
Practice Location | |||||||||
Address1: | 10000 BAY PINES BLVD. BLDG 100, RM 1E-203 | ||||||||
Address2: | BAY PINES VAHCS | ||||||||
City: | BAY PINES | ||||||||
State: | FL | ||||||||
PostalCode: | 33744 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7273986661 | ||||||||
FaxNumber: | 7273191332 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/15/2005 | ||||||||
LastUpdateDate: | 08/17/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/17/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | ME45736 | FL | Y |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   |
No ID Information.