Basic Information
| Provider Information | |||||||||
| NPI: | 1134113616 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOWARD P. CHARMAN, MD, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | UPLAND PATHOLOGY MEDICAL GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2311 | ||||||||
| Address2: | |||||||||
| City: | CHATSWORTH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913132311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187189500 | ||||||||
| FaxNumber: | 8187189507 | ||||||||
| Practice Location | |||||||||
| Address1: | 999 SAN BERNARDINO RD | ||||||||
| Address2: | |||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917864920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099852811 | ||||||||
| FaxNumber: | 9099203827 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2005 | ||||||||
| LastUpdateDate: | 06/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | CHARMAN | ||||||||
| AuthorizedOfficialFirstName: | HOWARD | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9099852811 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | GR0100590 | 05 | CA | MEDICAID |