Provider Demographics
NPI:1265418214
Name:MADER, CHARLES E (DO)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:MADER
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 1:2015 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-4932
Mailing Address - Country:US
Mailing Address - Phone:850-776-7250
Mailing Address - Fax:
Practice Address - Street 1:2015 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-4932
Practice Address - Country:US
Practice Address - Phone:850-776-7250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO-805207L00000X
FLOS 11309207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology