Provider Demographics
NPI:1356302095
Name:HESDORFFER, CHARLES S (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:S
Last Name:HESDORFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 RIVER BAY RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-4832
Mailing Address - Country:US
Mailing Address - Phone:917-991-7772
Mailing Address - Fax:
Practice Address - Street 1:10 CENTER DR RM 4-5140
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0004
Practice Address - Country:US
Practice Address - Phone:310-402-2339
Practice Address - Fax:310-594-1290
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169687207RH0003X
DCMD040886207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0088862Medicaid
E56028Medicare UPIN
NJ0088862Medicaid