Charles E Boetsch, MD
Individual provider Active NPI Diagnostic Radiology Physician · Cortland, OH
NPI 1194773705 · NPPES record last updated Dec 12, 2013
Key facts
- NPI
- 1194773705
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- 35.076482 (OH)
- Practice address
- 2588 Elm Road NE
Cortland, OH 44410-9298 - Phone
- (330) 841-5807
- Fax
- (330) 841-5858
- NPI assigned
- May 5, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35.076482 | OH | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Trumbull Radiologists Inc | Diagnostic Radiology | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 35.076482 | OH | Yes |
Addresses
Primary practice location
2588 Elm Road NE
Cortland, OH 44410-9298
Mailing address
2588 Elm Road NE
Cortland, OH 44410-9298
Phone (330) 841-5807
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2128192 | Medicaid | OH |
Other providers in Cortland, OH
- Mark A Betz
- Ross Gregory Blevins
- Blue Star Family Counseling Services, Inc.
- Thomas L Bobic
- Rachel Lynn Bockelman
- Jennifer Ann Borawiec
- Patrick Bornemiss
- Jared Bowen
- Cassandra Brackin
- Shelby Anne Brenkert
All providers in Cortland, OH · Diagnostic Radiology Physician in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 12, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.