Provider Demographics
NPI:1063472397
Name:STEFAN, CHARLES P (RPA-C)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:P
Last Name:STEFAN
Suffix:
Gender:M
Credentials:RPA-C
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:4401 MIDDLE SETTLEMENT RD
Mailing Address - Street 2:STE 102
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-5332
Mailing Address - Country:US
Mailing Address - Phone:315-735-4496
Mailing Address - Fax:315-735-7066
Practice Address - Street 1:4401 MIDDLE SETTLEMENT RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-5331
Practice Address - Country:US
Practice Address - Phone:315-735-4496
Practice Address - Fax:315-735-7066
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2019-04-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY008634363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P39057Medicare UPIN