Provider Demographics
NPI:1023122983
Name:DISKIN, CHARLES J (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:DISKIN
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 1:2609 VILLAGE PROFESSIONAL DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-5442
Mailing Address - Country:US
Mailing Address - Phone:334-749-6523
Mailing Address - Fax:334-742-0242
Practice Address - Street 1:2609 VILLAGE PROFESSIONAL DR
Practice Address - Street 2:SUITE 3
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5442
Practice Address - Country:US
Practice Address - Phone:334-749-6523
Practice Address - Fax:334-742-0242
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL104691207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000010756Medicaid
AL51088816OtherBCBS LANGDALE
AL009919305Medicaid
AL009948995Medicaid
AL51086405OtherBCBS TUSKEGEE
AL000088816Medicaid
AL009948975Medicaid
AL125726Medicaid
AL51520914OtherBCBS AUBURN
AL009948985Medicaid
ALCC1726OtherRRRMC
1023122983OtherNPI
AL125727Medicaid
AL51088820OtherBCBS DADEVILLE
AL000086405Medicaid
AL51010756OtherBCBS LAFAYETTE
AL51010757OtherBCBS OPELIKA
AL528701590Medicaid
AL009948995Medicaid