Individual
CHARLES M. WASSERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
7500 CENTRAL AVE STE 104, PHILADELPHIA, PA 19111-2431
(215) 742-0712
(215) 742-5218
Mailing address
7500 CENTRAL AVE STE 104, PHILADELPHIA, PA 19111-2431
(215) 742-0712
(215) 742-5218
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS006559L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015583070022
—
PA
01
—
0470055
CIGNA HMO/PPO
PA
01
—
080134444
RRM
PA
01
—
10938435
CAQH ID#
PA
01
—
4571206
AETNA PPO
PA
01
—
469591
AETNA HMO
PA
01
—
694010
HIGHMARK BLUE SHIELD
PA
Enumeration date
06/03/2006
Last updated
05/14/2021
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