Provider Demographics
NPI:1730149626
Name:HERMAN, CHARLES K (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:K
Last Name:HERMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:206 E BROWN ST
Mailing Address - Street 2:POCONO HEALTHCARE MANAGEMENT - PROFESSIONAL BLDG.
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3006
Mailing Address - Country:US
Mailing Address - Phone:570-420-4969
Mailing Address - Fax:570-476-3754
Practice Address - Street 1:100 PLAZA CT
Practice Address - Street 2:SUITE C
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8258
Practice Address - Country:US
Practice Address - Phone:570-420-6220
Practice Address - Fax:570-420-6221
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2013-07-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD426379208200000X
NY2232092086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013761380001Medicaid
PA1013761380001Medicaid
PA093749LJYMedicare ID - Type Unspecified