Provider Demographics
NPI:1881743292
Name:DILLON, CHARLES FREDERICK (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:FREDERICK
Last Name:DILLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3311 TOLEDO RD
Mailing Address - Street 2:ROOM 4217
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2064
Mailing Address - Country:US
Mailing Address - Phone:301-458-4685
Mailing Address - Fax:301-458-4028
Practice Address - Street 1:3311 TOLEDO RD
Practice Address - Street 2:ROOM 4217
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2064
Practice Address - Country:US
Practice Address - Phone:301-458-4685
Practice Address - Fax:301-458-4028
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA49642207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA49642OtherMEDICAL LICENSE NUMBER
MA49642OtherMEDICAL LICENSE NUMBER