Active NPI
Charmen W. Douglas, D.M.D
- General Practice Dentistry
- Gibbsboro, NJ
National Provider Identifier
1649206707
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 22DI01738100
- Practice address
- 146 Haddonfield Berlin Rd S
Suite#302
Gibbsboro, NJ 08026-1018 - Phone
- (856) 346-8900
- Fax
- (856) 346-8866
- NPI assigned
- Jun 23, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 22DI01738100 | NJ | Primary |
Addresses
Primary practice location
146 Haddonfield Berlin Rd S
Suite#302
Gibbsboro, NJ 08026-1018
Mailing address
146 Haddonfield-Berlin Road
Suite#302
Gibbsboro, NJ 08026
Phone (856) 346-8900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170316001506 | NJ | Order and Referring Only - Dentist | 6305121260 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22DI01738100 | NJ | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1649206707",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "146 HADDONFIELD-BERLIN ROAD",
"address_2": "SUITE#302",
"city": "GIBBSBORO",
"state": "NJ",
"postal_code": "08026",
"telephone_number": "856-346-8900",
"fax_number": "856-346-8866"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "146 HADDONFIELD BERLIN RD S",
"address_2": "SUITE#302",
"city": "GIBBSBORO",
"state": "NJ",
"postal_code": "080261018",
"telephone_number": "856-346-8900",
"fax_number": "856-346-8866"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGLAS",
"first_name": "CHARMEN",
"middle_name": "W.",
"name_prefix": "Dr.",
"credential": "D.M.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NJ",
"license": "22DI01738100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gibbsboro, NJ
- Clinical Therapeutics, LLC
- Gerard Corsi Jr., D.M.D.
- Debra Malley, MD LLC
- Kimberly Jeanne Deery, D.O.
- Donald J Baker M D L L C
- Dr. Christopher M Larosa LLC
- Eihab Human Services New Jersey, Inc.
- Eihab Human Services New Jersey, Inc.
- Eihab Human Services New Jersey, Inc.
- Eihab Human Services New Jersey, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.