Individual
DR. CHARLES D RADIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
51 SEWALL ST, PORTLAND, ME 04102-2643
(207) 774-5761
(207) 874-7478
Mailing address
51 SEWALL ST, PORTLAND, ME 04102-2643
(207) 774-5761
(207) 874-7478
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1041
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0673610001
DMERC
ME
01
—
110116560
PALMETTOG RAILROAD MEDICARE
ME
05
—
115940199
—
ME
Enumeration date
08/26/2005
Last updated
08/26/2010
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