Marvin B Charles, M.D.
Individual provider Active NPI Surgery Physician · Warrensburg, MO
NPI 1548208366 · NPPES record last updated Jul 29, 2013
Key facts
- NPI
- 1548208366
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 2006033941 (MO)
- Practice address
- 510 Foster Lane
Suite 201
Warrensburg, MO 64093-3101 - Phone
- (660) 747-5558
- Fax
- (660) 429-4169
- NPI assigned
- Jun 3, 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 |
|---|---|---|---|
| 2006033941 | MO | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Adventist Health Clearlake Hospital Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 2006033941 | MO | Yes |
Addresses
Primary practice location
510 Foster Lane
Suite 201
Warrensburg, MO 64093-3101
Mailing address
P.O. Box 1074
Warrensburg, MO 64093-3101
Phone (660) 747-5558
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548208366 | Medicaid | MO | |
| 227883 | Other | MO | HEALTHCARE USA |
Other providers in Warrensburg, MO
- Susan Cavender
- Cedar Oaks Surgery Center LLC
- Central Family Medicine, Inc
- Central Physical Rehabilitation and Sports Medicine, LLC
- Kelsy Chapman
- Brianne Cherry
- Chirohealth PA
- Boerie Tommy Chun
- Alahana Kuwai Cisneros
- Olivia Clark
All providers in Warrensburg, MO · Surgery Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 29, 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.