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Individual

CHARLES MICHAEL WAX

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2 COLGATE DR, SUITE 104, FOREST HILL, MD 21050-2624
(410) 838-1051
(410) 838-5325
Mailing address
1617 N BEND RD, JARRETTSVILLE, MD 21084-1329
(410) 838-1051
(410) 838-5325

Taxonomy

Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
D0024542
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
010183
EMPLOYEE HEALTH PLAN
MD
01
1930001
BXBS BLUE CHOICE HMO
DC
01
1930001
BXBS FEDERAL
MD
01
290708
ALLIANCE PPO
MD
01
34076
COVENTRY HEALTHCARE
DE
01
3711148
CIGNA HEALTHCARE
CT
01
4217234
AETNA HEALTHCARE
PA
01
494353
NATIONAL CAPITOL PPO
DC
01
67160
PRIVATE HEALTHCARE SYSTEM
01
8905CM
MARYLAND BXBS
MD
Enumeration date
07/10/2006
Last updated
09/04/2008
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