Basic Information
| Provider Information | |||||||||
| NPI: | 1902916984 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARTLAND | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1803 MOUNT ROSE AVE | ||||||||
| Address2: | SUITE B3 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174033026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178511405 | ||||||||
| FaxNumber: | 7178122163 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 PINE GROVE COMMONS | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174035176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178122143 | ||||||||
| FaxNumber: | 7178122163 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 06/13/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OS005851L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 30123003 - RDYCARE | 01 | PA | AMERIHEALTH MERCY - WMG | OTHER | 30100250 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 145795 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 30123001 - CAREEXP. | 01 | PA | AMERIHEALTH MERCY - WMG | OTHER | 974202 | 01 | MD | CAREFIRST MD | OTHER | 001160920 | 05 | PA | MEDICAID | 417112 | 01 | PA | UPMC | OTHER | P010507 | 01 | PA | GATEWAY | OTHER |