Provider Demographics
NPI:1902958879
Name:CHARLES STREET OBGYN ASSIOCIATES
Entity Type:Organization
Organization Name:CHARLES STREET OBGYN ASSIOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:OTTENRITTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-823-1120
Mailing Address - Street 1:6565 N CHARLES ST
Mailing Address - Street 2:PHYSICIANS PAVILION EAST SUITE 212
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6800
Mailing Address - Country:US
Mailing Address - Phone:410-823-1120
Mailing Address - Fax:410-296-9009
Practice Address - Street 1:6565 N CHARLES ST
Practice Address - Street 2:PHYSICIANS PAVILION EAST SUITE 212
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-6800
Practice Address - Country:US
Practice Address - Phone:410-823-1120
Practice Address - Fax:410-296-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty