Provider Demographics
NPI:1538217872
Name:FEIN, CHARLES LEWIS (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:LEWIS
Last Name:FEIN
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:PO BOX 2672
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-3007
Mailing Address - Country:US
Mailing Address - Phone:818-268-5453
Mailing Address - Fax:
Practice Address - Street 1:4350 NW CANARY PL
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330
Practice Address - Country:US
Practice Address - Phone:818-268-5453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA34393207R00000X
HIMD-9554207R00000X
NMMD2019-0627207R00000X
ORMD20979207R00000X
CAG78781207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR085659Medicaid
WA8204380Medicaid
WA8204380Medicaid