Provider Demographics
NPI:1144438748
Name:DORFMAN, CHARLES EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDWARD
Last Name:DORFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:974 INNSWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-2807
Mailing Address - Country:US
Mailing Address - Phone:407-427-0855
Mailing Address - Fax:855-908-2515
Practice Address - Street 1:405 S PARK AVE
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5261
Practice Address - Country:US
Practice Address - Phone:407-884-7774
Practice Address - Fax:407-884-9770
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057240208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology