Active NPI
Charles R Maris, MD
- Otolaryngology Physician
- Urbana, IL
National Provider Identifier
1932170982
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 036-056584
- Practice address
- 602 W. University Avenue
Otolaryngology
Urbana, IL 61801 - Phone
- (217) 383-3130
- Fax
- (217) 383-4451
- NPI assigned
- Jan 29, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 036-056584 | IL | Primary |
Addresses
Primary practice location
602 W. University Avenue
Otolaryngology
Urbana, IL 61801
Mailing address
P.O. Box 6002
Urbana, IL 61803-6002
Phone (217) 326-8300
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-056584 | IL | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138492800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339372800000",
"number": "1932170982",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 6002",
"city": "URBANA",
"state": "IL",
"postal_code": "618036002",
"telephone_number": "217-326-8300",
"fax_number": "217-383-4451"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "602 W. UNIVERSITY AVENUE",
"address_2": "OTOLARYNGOLOGY",
"city": "URBANA",
"state": "IL",
"postal_code": "61801",
"telephone_number": "217-383-3130",
"fax_number": "217-383-4451"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARIS",
"first_name": "CHARLES",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-29",
"last_updated": "2012-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "IL",
"license": "036-056584",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Urbana, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.