Provider Demographics
NPI:1861566481
Name:CHARLES, HAROLD (PA)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:CHARLES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7831 PARSONS BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1929
Mailing Address - Country:US
Mailing Address - Phone:718-969-7000
Mailing Address - Fax:718-380-1775
Practice Address - Street 1:7831 PARSONS BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11366-1929
Practice Address - Country:US
Practice Address - Phone:718-969-7000
Practice Address - Fax:718-380-1775
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008352363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical