Provider Demographics
NPI:1093949869
Name:JEAN CHARLES, PIERRE MAXIME (MD)
Entity Type:Individual
Prefix:
First Name:PIERRE
Middle Name:MAXIME
Last Name:JEAN CHARLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 UPPER FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14605-2184
Mailing Address - Country:US
Mailing Address - Phone:585-922-0200
Mailing Address - Fax:
Practice Address - Street 1:293 UPPER FALLS BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14605-2184
Practice Address - Country:US
Practice Address - Phone:585-922-0200
Practice Address - Fax:585-922-0230
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-08
Last Update Date:2013-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03134452Medicaid
NY03134452Medicaid