Provider Demographics
NPI:1043271562
Name:LEDNUM, CHARLES NOBLE III (MA)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:NOBLE
Last Name:LEDNUM
Suffix:III
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MARYLAND AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-1928
Mailing Address - Country:US
Mailing Address - Phone:410-228-1676
Mailing Address - Fax:410-228-7464
Practice Address - Street 1:400 MARYLAND AVE STE 1
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1928
Practice Address - Country:US
Practice Address - Phone:410-228-1676
Practice Address - Fax:410-228-7464
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001234231H00000X
DE02-0000132231H00000X
MD01025237600000X
VA2101 001488237600000X
DE231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDJ207-00-01OtherCAREFIRST BLUECHOICE
MD158SMedicare ID - Type Unspecified