| Doctor Name: | CHARLES ANTHONY DORAM |
| NPI Number: | 1346494895 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CSAC |
| License Number: | 312574 |
| Business Practice Address: | 2829 Royal Ave Monona, WI - 537131535 |
| Business Phone Number: | 6086612829 |
| Business Fax Number: | 6086610907 |
| Mailing Address: | 2829 Royal Ave Ste 200, MONONA |
| State: | WI |
| Postal Code: | 537131535 |
| Phone Number: | 6086612829 |
| Fax Number: | 6086610907 |
| NPI Enumeration Date: | 11/11/2008 |
| NPI Last Update Date: | 11/12/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 312574 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |