Provider Demographics
NPI:1538171517
Name:DAWSON, CHARLES BARTHOLOMEW (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:BARTHOLOMEW
Last Name:DAWSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:210 E GRAY ST STE 1002
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3906
Practice Address - Country:US
Practice Address - Phone:502-584-2029
Practice Address - Fax:502-584-0873
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39393207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200908720Medicaid
KY000000708286OtherANTHEM- CTS
KY50020741OtherPASSPORT
KY50031616OtherPASSPORT- CARDIOTHORACIC SURGERY OF LOUISVILLE
KY2432852000OtherPASSPORT ADVANTAGE
KY000057094NOtherHUMANA- CTS
KY7100044790Medicaid
P00627662OtherTRAVELERS MEDICARE
IN200908720Medicaid
IN890680JMedicare PIN
KY0231411Medicare PIN
KY2432852000OtherPASSPORT ADVANTAGE