Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 15126R | LA |
N | 207X00000X | Orthopaedic Surgeon | 35090817 | OH |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 35090817 | OH |
NPI | 1093705063 |
---|---|
Provider Name | Dr. Daniel Alexander Charlick |
First Address | Canton, OH 44718-3603 |
Second Address | Canton, OH 44718-3603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2005 |
Last Update Date | 18/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD000 | (02) |