Individual
DR. CHARLES M NIETO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4789 STATE RD, RIDGEVILLE, SC 29472-6921
(843) 688-5311
Mailing address
2960 TONGASS AVE, KETCHIKAN, AK 99901-5742
(907) 228-4900
(907) 228-4905
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
218850
NY
207R00000X
Internal Medicine Physician
DR44149
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
44929064
—
CO
Enumeration date
01/19/2006
Last updated
07/21/2022
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