Provider Demographics
NPI:1801166293
Name:WAHNON, CHARLES L (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:L
Last Name:WAHNON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:40 EVERGREEN ROW
Mailing Address - Street 2:
Mailing Address - City:ARMONK
Mailing Address - State:NY
Mailing Address - Zip Code:10504-2210
Mailing Address - Country:US
Mailing Address - Phone:914-273-8754
Mailing Address - Fax:914-273-3847
Practice Address - Street 1:40 EVERGREEN ROW
Practice Address - Street 2:
Practice Address - City:ARMONK
Practice Address - State:NY
Practice Address - Zip Code:10504-2210
Practice Address - Country:US
Practice Address - Phone:914-273-8754
Practice Address - Fax:914-273-3847
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY113959-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology