Individual
DR. CHARLES M. INTENZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 S. 11TH STREET, SUITE 3390, PHILADELPHIA, PA 19107-4824
(215) 955-2900
(215) 923-1562
Mailing address
111 S. 11TH STREET, SUITE 3390, PHILADELPHIA, PA 19107-4824
(215) 955-2900
(215) 923-1562
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
Primary
MD025932E
PA
2085R0202X
Diagnostic Radiology Physician
MD025932E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001073932
—
PA
05
—
0010739320009
—
PA
05
—
6377505
—
NJ
Enumeration date
07/08/2006
Last updated
12/10/2019
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