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Deactivated NPI 1114416708 Deactivated / Inactive NPI Male Practitioner

Dr. Charlie Vidal , MD

General Practice • Utuado, PR

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Charlie Vidal has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date May 09, 2018
NPI Deactivation Date April 18, 2022
Total Practice Duration ~4 Years of Practice (2018 – 2022)

Professional Overview & Biography Verified Profile Summary

Dr. Charlie Vidal, MD was a registered General Practice practicing in Utuado, PR. Throughout an active medical career spanning 4 years, Dr. Vidal provided care at the practice location at CALLE DR. CUETO #70 until profile deactivation on 2022-04-18.

Practice Location & Contact Primary Location

Practice Address

Calle Dr. Cueto #70

Utuado, PR 00641

Telephone 8605784969
Associated Practice Facility / Clinic
🏢 Dorado Health Inc Facility NPI 1376605170

Specialty Benchmarks & Practice Insights

Comparative analytics for General Practice in Utuado, PR

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 20.5 Yrs
State Avg: 25.4 Yrs
Regional Practice Density
28 Specialists

Practicing in Utuado, PR (4449 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2026-07-02
General Practice Primary Specialty

NUCC Taxonomy Code: 208D00000X

State License PR 25043

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

18 Historical Events
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Updated Practice Location July 02, 2026

Registered at CALLE DR. CUETO #70, UTUADO, PR 00641 (Tel: 8605784969)

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Updated Business Mailing Address July 02, 2026

Registered at CALLE HERNANDEZ CARRION, MANATI, PR 00674 (Tel: 7876213700)

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Provider Name / Credentials Updated July 02, 2026

Recorded as CHARLIE VIDAL, MD

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 02, 2026

General Practice (License #25043 in PR)

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Updated Practice Location March 15, 2023

Registered at 123 ST IN PUERTO RICO, SAN JUAN, PR 00918 (Tel: 7872420101)

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Updated Business Mailing Address March 15, 2023

Registered at 123 ST IN PUERTO RICO, SAN JUAN, PR 00918

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Medical Taxonomy / Specialty Registered (Primary Specialty) March 15, 2023

General Practice (License #16158-I in PR)

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Updated Practice Location December 15, 2022

Registered at CARR 5523 KM 4.4, BO ARENAS, UTUADO, PR 00641 (Tel: 7872429604)

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Updated Business Mailing Address December 15, 2022

Registered at HC 4 BOX 10578, UTUADO, PR 006417518

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Provider Name / Credentials Updated December 15, 2022

Recorded as CHARLIE VIDAL, MD, MPH, MBA

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Medical Taxonomy / Specialty Registered (Primary Specialty) December 15, 2022

Health Educator

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NPI Profile Deactivated April 18, 2022

Record deactivated on April 18, 2022

NPI Profile Active May 09, 2018

NPI status registered as active in NPPES database

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Updated Practice Location May 09, 2018

Registered at CARR 5523 KM 4.4, BO ARENAS, UTUADO, PR 00641 (Tel: 7872429604)

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Updated Business Mailing Address May 09, 2018

Registered at HC 4 BOX 10578, UTUADO, PR 006417518

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Provider Name / Credentials Updated May 09, 2018

Recorded as CHARLIE VIDAL, MD, MPH, MBA

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Medical Taxonomy / Specialty Registered (Primary Specialty) May 09, 2018

Clinic/Center

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Initial NPI Registration & Enumeration May 09, 2018

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1114416708
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: May 09, 2018
Last Update: July 02, 2026
Deactivation Date: April 18, 2022
Sole Proprietor: Yes

Mailing Address

Calle Hernandez Carrion

Manati, PR 00674

Phone: 7876213700

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.