Provider Demographics
NPI:1831393271
Name:DALMEDO, CHARLES ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ALEXANDER
Last Name:DALMEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 SUNRISE HWY
Mailing Address - Street 2:STAT HEALTH
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-6012
Mailing Address - Country:US
Mailing Address - Phone:631-581-5900
Mailing Address - Fax:
Practice Address - Street 1:1850 SUNRISE HWY
Practice Address - Street 2:STAT HEALTH
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6012
Practice Address - Country:US
Practice Address - Phone:631-581-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244413207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine