Provider Demographics
NPI:1487752911
Name:MARDIS, CHARLES GREGORY (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:GREGORY
Last Name:MARDIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5816 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-3106
Mailing Address - Country:US
Mailing Address - Phone:612-333-0156
Mailing Address - Fax:
Practice Address - Street 1:3500 MEMORIAL PKWY SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5318
Practice Address - Country:US
Practice Address - Phone:256-536-4700
Practice Address - Fax:256-536-4117
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2024-07-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL23196207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine