Individual
CHARLES THOMAS HENNEMEYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 W ARBOR DR, SAN DIEGO, CA 92103-9000
(800) 926-8273
(888) 539-8781
Mailing address
PO BOX 232410, SAN DIEGO, CA 92193-2410
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A82709
CA
2085R0202X
Diagnostic Radiology Physician
CDR.0004462
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A827090
—
CA
05
—
9000237093
—
CO
Enumeration date
06/05/2006
Last updated
03/25/2025
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