Provider Demographics
NPI:1003851353
Name:DEWING, CHARLES WARREN (PA)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:WARREN
Last Name:DEWING
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 1:2414 15TH ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-1701
Mailing Address - Country:US
Mailing Address - Phone:518-271-1813
Mailing Address - Fax:518-271-1931
Practice Address - Street 1:2414 15TH ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-1701
Practice Address - Country:US
Practice Address - Phone:518-271-1813
Practice Address - Fax:518-271-1931
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1012670363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPA0050Medicare ID - Type Unspecified
NYS14702Medicare UPIN