Provider Demographics
NPI:1730174723
Name:HURWITZ, CHARLES (DO)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:HURWITZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E CHESTER PK
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-1709
Mailing Address - Country:US
Mailing Address - Phone:610-521-4677
Mailing Address - Fax:
Practice Address - Street 1:204 E CHESTER PK
Practice Address - Street 2:SUITE 4
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-1709
Practice Address - Country:US
Practice Address - Phone:610-521-4677
Practice Address - Fax:610-521-0951
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002981174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100015342OtherTRAVELERS MEDICARE
PA0046027000OtherKEYSTONE
PA2381887OtherAETNA
PA32647OtherKEYSTONE MERCY
PA016693OtherBLUE SHIELD
PA2381887OtherAETNA