Basic Information
| Provider Information | |||||||||
| NPI: | 1457797755 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ODONKOR | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 47 COLLEGE ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8779253637 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 633 MIDDLESEX TPKE | ||||||||
| Address2: | |||||||||
| City: | OLD SAYBROOK | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064751220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8779253637 | ||||||||
| FaxNumber: | 2037856798 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2013 | ||||||||
| LastUpdateDate: | 08/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 61239 | CT | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 208100000X | 61239 | CT | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.