Individual
DR. CHARLES W KEBLUSEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.,F.A.C.O.G.,P.C.
Contact information
Practice address
1409 HUGUENOT RD, MIDLOTHIAN, VA 23113-2603
(804) 706-5827
(804) 706-5819
Mailing address
12501 TRITON SPRINGS DR, MIDLOTHIAN, VA 23114-7140
(804) 379-7579
(804) 379-9701
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
0101027033
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006206841
—
VA
05
—
1477586766
—
VA
Enumeration date
07/09/2006
Last updated
08/19/2008
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