Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 200400468 | NC |
N | 207X00000X | Orthopaedic Surgeon | 42-0011585 | VT |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 42-0011585 | VT |
NPI | 1154374734 |
---|---|
Provider Name | Dr. Mark David Charlson |
First Address | South Burlington, VT 05403-4440 |
Second Address | South Burlington, VT 05403-4440 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 25/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1015272 | (05) | VT |
H64304 | (02) |