Provider Demographics
NPI:1164720066
Name:CHARTER, ABIGAIL R (PA)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:R
Last Name:CHARTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:MACOMBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:100 PARK STREET
Mailing Address - Street 2:GLENS FALLS HOSPITAL - CREDENTIALING
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4413
Mailing Address - Country:US
Mailing Address - Phone:518-926-5924
Mailing Address - Fax:518-926-6983
Practice Address - Street 1:100 PARK ST
Practice Address - Street 2:GLENS FALLS HOSPITAL - HOSPITALIST PROGRAM
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4413
Practice Address - Country:US
Practice Address - Phone:518-926-5925
Practice Address - Fax:518-926-5917
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014600363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03685494Medicaid
NYJ400043752Medicare PIN