Individual
CHARLES T CLINE
Active
Individual
CHARLES T CLINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
01025220A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000191345
ANTHEM PROVIDER NUMBER
IN
05
—
100231100
—
IN
01
—
10824917
CAQH NUMBER
IN
01
—
9006422
PHCS PID NUMBER
IN
05
—
CL80450010
—
IN
01
—
E03843
MEDICARE UPIN NUMBER
IN
Enumeration date
03/15/2006
Last updated
07/23/2012
Update your record
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