Provider Demographics
NPI:1093734436
Name:CHARLES, SANDRA K (DO)
Entity Type:Individual
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First Name:SANDRA
Middle Name:K
Last Name:CHARLES
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:1 HOSPITAL DR STE 306
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9350
Mailing Address - Country:US
Mailing Address - Phone:570-522-4110
Mailing Address - Fax:570-768-3911
Practice Address - Street 1:935 ROUTE 522
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-9714
Practice Address - Country:US
Practice Address - Phone:570-372-6102
Practice Address - Fax:570-372-6110
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-05-23
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Provider Licenses
StateLicense IDTaxonomies
PAOS008937L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA118438702OtherDEPARTMENT OF LABOR
PA0016096200008Medicaid
PAP00121999OtherRAILROAD MEDICARE
PA02185103OtherBLUE CROSS
PA232809429OtherTRICARE
PAG38215OtherHEALTH AMERICA
PA02185103OtherKEYSTONE
PA15357C3AAOtherGEISINGER
PA894313OtherBLUE SHIELD