Provider Demographics
NPI:1053696187
Name:MATOUK, CHARLES CHRISTIAN (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CHRISTIAN
Last Name:MATOUK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 208082, 333 CEDAR STREET, TMP 402
Mailing Address - Street 2:YALE UNIVERSITY, DEPARTMENT OF NEUROSURGERY
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3206
Mailing Address - Country:US
Mailing Address - Phone:203-737-2096
Mailing Address - Fax:203-785-2044
Practice Address - Street 1:800 HOWARD AVE
Practice Address - Street 2:LOWER LEVEL, NEUROSCIENCE CENTER
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1369
Practice Address - Country:US
Practice Address - Phone:203-737-2096
Practice Address - Fax:203-785-2044
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2012-09-19
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Provider Licenses
StateLicense IDTaxonomies
CT50158207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery