Active NPI
Charles Michael Wax, M.D.
- Pediatric Adolescent Medicine Physician
- Forest Hill, MD
National Provider Identifier
1184658148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Adolescent Medicine Physician
- License
- D0024542
- Practice address
- 2 Colgate Dr
Suite 104
Forest Hill, MD 21050-2624 - Phone
- (410) 838-1051
- Fax
- (410) 838-5325
- NPI assigned
- Jul 10, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Adolescent Medicine Physician | 2080A0000X | D0024542 | MD | Primary |
Addresses
Primary practice location
2 Colgate Dr
Suite 104
Forest Hill, MD 21050-2624
Mailing address
1617 N Bend Rd
Jarrettsville, MD 21084-1329
Phone (410) 838-1051
Other identifiers 15
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 290708 | Other | MD | ALLIANCE PPO |
| 67160 | Other | PRIVATE HEALTHCARE SYSTEM | |
| 010183 | Other | MD | EMPLOYEE HEALTH PLAN |
| 290708 | Other | MD | MD-IPA |
| 3711148 | Other | CT | CIGNA HEALTHCARE |
| 1930001 | Other | MD | BXBS FEDERAL |
| 34076 | Other | DE | COVENTRY HEALTHCARE |
| 494353 | Other | DC | NATIONAL CAPITOL PPO |
| 1930001 | Other | DC | BXBS BLUE CHOICE HMO |
| 290708 | Other | MD | OPTIMUM CHOICE HMO |
| 290708 | Other | MD | UNITED HEALTHCARE |
| 8905CM | Other | MD | MARYLAND BXBS |
| 010183 | Other | MD | JOHNS HOPKINS HEALTH PLAN |
| 290708 | Other | MD | MAMSI LIFE AND HEALTH |
| 4217234 | Other | PA | AETNA HEALTHCARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Interoperability endpoints
- https://api.platform.athenahealth.com/16965/brand/1/csg/1/fhir/r4
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1220486400000",
"number": "1184658148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1617 N BEND RD",
"city": "JARRETTSVILLE",
"state": "MD",
"postal_code": "210841329",
"telephone_number": "410-838-1051",
"fax_number": "410-838-5325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 COLGATE DR",
"address_2": "SUITE 104",
"city": "FOREST HILL",
"state": "MD",
"postal_code": "210502624",
"telephone_number": "410-838-1051",
"fax_number": "410-838-5325"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAX",
"first_name": "CHARLES",
"middle_name": "MICHAEL",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-10",
"last_updated": "2008-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "2080A0000X",
"taxonomy_group": "",
"desc": "Pediatrics, Adolescent Medicine",
"state": "MD",
"license": "D0024542",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALLIANCE PPO",
"identifier": "290708",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRIVATE HEALTHCARE SYSTEM",
"identifier": "67160",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMPLOYEE HEALTH PLAN",
"identifier": "010183",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MD-IPA",
"identifier": "290708",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA HEALTHCARE",
"identifier": "3711148",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BXBS FEDERAL",
"identifier": "1930001",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COVENTRY HEALTHCARE",
"identifier": "34076",
"state": "DE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONAL CAPITOL PPO",
"identifier": "494353",
"state": "DC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BXBS BLUE CHOICE HMO",
"identifier": "1930001",
"state": "DC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OPTIMUM CHOICE HMO",
"identifier": "290708",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "290708",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MARYLAND BXBS",
"identifier": "8905CM",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "JOHNS HOPKINS HEALTH PLAN",
"identifier": "010183",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAMSI LIFE AND HEALTH",
"identifier": "290708",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HEALTHCARE",
"identifier": "4217234",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Forest Hill, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.