Provider Demographics
NPI:1174599682
Name:ST. CHARLES, MARISE (DO)
Entity type:Individual
Prefix:
First Name:MARISE
Middle Name:
Last Name:ST. CHARLES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 S CENTRAL AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-2340
Mailing Address - Country:US
Mailing Address - Phone:914-793-5588
Mailing Address - Fax:
Practice Address - Street 1:141 S CENTRAL AVE STE 205
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-2340
Practice Address - Country:US
Practice Address - Phone:914-793-5588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257178207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology