DR. CHARLES D RADIS (NPI# 1235122094) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235122094 |
| Entity Type | Individual |
| Full Name | DR. CHARLES D RADIS |
| Credential | DO |
| Practice Address |
51 Sewall St Portland ME 04102-2643 |
| Practice Telephone | 2077745761 |
| Practice Fax Number | 2078747478 |
| Mailing Telephone | 2077745761 |
| Mailing Fax Number | 2078747478 |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2010-08-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 1041 | ME | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ME | DMERC | 0673610001 | 01 |
| ME | 115940199 | 05 | |
| ME | PALMETTOG RAILROAD MEDICARE | 110116560 | 01 |
| Street Address |
51 SEWALL ST |
| City | PORTLAND |
| State | ME |
| Zip Code | 04102-2643 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891788659 | Brian J Keroack | Specialist | 51 Sewall St, Portland, ME 04102-2643 | 2005-08-26 |
| 1487885588 | Rheumatology Associates | Specialist | 51 Sewall St, Portland, ME 04102-2643 | 2009-08-06 |
| 1366616252 | Elizabeth D Evans | Physician Assistant | 51 Sewall St, Portland, ME 04102-2643 | 2008-04-22 |
| 1003098252 | Rheumatology Associates P.a. | Specialist | 51 Sewall St, Portland, ME 04102-2643 | 2007-11-29 |
| 1144420332 | Fore River Family Medicine, Pa | Family Medicine | 51 Sewall St, Portland, ME 04102-2643 | 2007-07-25 |
| 1508086083 | Edward Fels | Specialist | 51 Sewall St, Portland, ME 04102-2643 | 2007-04-26 |
| 1619914587 | Stephanie Gartner-fanburg | Internal Medicine | 51 Sewall St, Rheumatology Associates, Pa, Portland, ME 04102-2643 | 2006-06-01 |
| 1508834441 | Catherine Crute | Family Medicine | 51 Sewall St, Portland, ME 04102-2643 | 2006-03-08 |
| 1184617953 | Brian E Daikh | Specialist | 51 Sewall St, Portland, ME 04102-2643 | 2005-08-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720602964 | Ci Yen Joanna Man | Student in an Organized Health Care Education/Training Program | 190 Park Ave., Portland, ME 04102 | 2020-06-03 |
| 1841811338 | Abby Zarotny Sahagian | Nurse Anesthetist, Certified Registered | Mmc Anesthesia and Perioperative Medicine, 22 Bramhall St, Portland, ME 04102 | 2020-05-06 |
| 1124656863 | Zachary Bernard Tillett | Student in an Organized Health Care Education/Training Program | Maine Medical Center 22 Bramhall St., Portland, ME 04102 | 2020-03-30 |
| 1215564323 | Joshua Allen Swenson | Student in an Organized Health Care Education/Training Program | 33 Bramhall St, Portland, ME 04102 | 2020-03-26 |
| 1740776434 | Rishi Phakey | Dentist | Community Dental, 190 Park Ave, Portland, ME 04102 | 2018-07-05 |
| 1982192571 | Jessica Thomas | Doula | 619 Brighton Ave #101, Rosemont Wellness Center, Portland, ME 04102 | 2018-04-29 |
| 1699270744 | Shane D Kirkegaard | Student in an Organized Health Care Education/Training Program | Maine Medical Center 22 Bramhall Street, Portland, ME 04102 | 2018-03-29 |
| 1144752494 | Al-shawk Home Healthcare, LLC | Technician | 640 Brighton Ave Ste 8, Portland, ME 04102 | 2017-03-28 |
| 1376074674 | Samuel B Potter | Emergency Medicine | Maine Medical Center, 22 Bramhall Street, Portland, ME 04102 | 2017-03-27 |
| 1043767536 | Kevin De Ruiter | Social Worker | 129 Pine St Apt 6, Portland, ME 04102 | 2016-09-01 |
| Find all providers in zip 04102 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
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| 1780294181 | Cynthia R Mendoza | Specialist | 2245 Se Powell Blvd, Portland, OR 97202-2143 | 2020-07-31 |
| 1679199335 | Alter Image, Inc. | Specialist | 2340 Se Gladstone St, Portland, OR 97202-2962 | 2020-06-18 |
| 1770044281 | Donnissa Smith | Specialist | 117 Se 129th Ave, Portland, OR 97233-1503 | 2019-03-27 |
| 1588191258 | Jason Moore | Specialist | 522 Ne Thompson St, Portland, OR 97212-3843 | 2017-05-12 |
| 1578097218 | Alicia N Keys | Specialist | 10480 Sw Eastridge St Apt 88, Portland, OR 97225-5047 | 2017-04-19 |
| 1942734736 | Mom By Lj | Specialist | 2906 N Willamette Blvd, Portland, OR 97217-4073 | 2017-04-18 |
| 1659811198 | Ricardo H. Medina | Specialist | 1400 Nw Irving St Apt 709, Portland, OR 97209-2260 | 2017-03-02 |
| 1730626805 | Jennifer Frank | Specialist | 1008 Se 112th Ave, Portland, OR 97216-3516 | 2017-01-26 |
| 1720523012 | Andrea Lett | Specialist | 4627 Ne 30th Ave, Portland, OR 97211-7001 | 2016-12-22 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.