Provider Demographics
NPI:1043384282
Name:LANDEN, CHARLES N JR (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:N
Last Name:LANDEN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1240 LEE ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-0001
Practice Address - Country:US
Practice Address - Phone:434-924-5100
Practice Address - Fax:434-982-1840
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101256844207VX0201X
TXM0466207VX0201X
AL29546207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051599004OtherBCBS
AL051599000OtherBCBS
AL130391Medicaid
MS00572712Medicaid
AL051598996OtherBCBS
AL051599001OtherBCBS
AL111036Medicaid
AL111039Medicaid
AL111046Medicaid
AL111051Medicaid
AL051598998OtherBCBS
TX174654701Medicaid
AL111035Medicaid
AL111046Medicaid
AL051599004OtherBCBS
AL102I988512Medicare PIN