Basic Information
| Provider Information | |||||||||
| NPI: | 1063440527 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GETZ | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | LONNIE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 833 CHESTNUT ST STE 520 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003219999 | ||||||||
| FaxNumber: | 2673393761 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 EVERGREEN DR STE 201 | ||||||||
| Address2: | |||||||||
| City: | GLEN MILLS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193421053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2673393558 | ||||||||
| FaxNumber: | 2673393763 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 02/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 25MA07849700 | NJ | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 307588 | NY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | ME152802 | FL | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | MD072654L | PA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2205831 | 01 | CIGNA | OTHER | 2404764000 | 01 | NJ | IBC | OTHER | 3279957 | 01 | AETNA | OTHER | 2181382000 | 01 | PA | IBC | OTHER |