Provider Demographics
NPI:1275529554
Name:CHARLEBOIS, MELISSA A (RPA C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:CHARLEBOIS
Suffix:
Gender:F
Credentials:RPA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 WASHINGTON ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-4063
Mailing Address - Country:US
Mailing Address - Phone:315-788-1751
Mailing Address - Fax:315-788-9021
Practice Address - Street 1:826 WASHINGTON ST
Practice Address - Street 2:SUITE 204
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4063
Practice Address - Country:US
Practice Address - Phone:315-788-1751
Practice Address - Fax:315-788-9021
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0102671363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02634577Medicaid
NY02634577Medicaid
Q28504Medicare UPIN