Basic Information
| Provider Information | |||||||||
| NPI: | 1902958879 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHARLES STREET OBGYN ASSIOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6565 N CHARLES ST | ||||||||
| Address2: | PHYSICIANS PAVILION EAST SUITE 212 | ||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212046800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108231120 | ||||||||
| FaxNumber: | 4102969009 | ||||||||
| Practice Location | |||||||||
| Address1: | 6565 N CHARLES ST | ||||||||
| Address2: | PHYSICIANS PAVILION EAST SUITE 212 | ||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212046800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108231120 | ||||||||
| FaxNumber: | 4102969009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | OTTENRITTER | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4108231120 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.