Basic Information
| Provider Information | |||||||||
| NPI: | 1043384282 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANDEN | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | N. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9007 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229069007 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1240 LEE ST | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229080001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349245100 | ||||||||
| FaxNumber: | 4349821840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 09/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0201X | 0101256844 | VA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
ID Information
| ID | Type | State | Issuer | Description | 051599001 | 01 | AL | BCBS | OTHER | 051598998 | 01 | AL | BCBS | OTHER | 111046 | 05 | AL | MEDICAID | 051599000 | 01 | AL | BCBS | OTHER | 130391 | 05 | AL | MEDICAID | 174654701 | 05 | TX | MEDICAID | 00572712 | 05 | MS | MEDICAID | 111039 | 05 | AL | MEDICAID | 111051 | 05 | AL | MEDICAID | 051598996 | 01 | AL | BCBS | OTHER | 111035 | 05 | AL | MEDICAID | 111036 | 05 | AL | MEDICAID | 051599004 | 01 | AL | BCBS | OTHER |