Provider Demographics
NPI:1861592800
Name:SZABO, CHARLES S (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:S
Last Name:SZABO
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 1:5 COMPTON CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941
Mailing Address - Country:US
Mailing Address - Phone:415-380-9777
Mailing Address - Fax:
Practice Address - Street 1:5 COMPTON CIRCLE
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941
Practice Address - Country:US
Practice Address - Phone:415-380-9777
Practice Address - Fax:415-380-8649
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44834208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00087585OtherUS RAIL ROAD MCARE
P00087585OtherUS RAIL ROAD MCARE
00G448340Medicare ID - Type Unspecified