Provider Demographics
NPI:1346377934
Name:CHARLES, SANDRA M (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:M
Last Name:CHARLES
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1300 CARAWAY CT STE 105
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5462
Mailing Address - Country:US
Mailing Address - Phone:202-684-6188
Mailing Address - Fax:301-925-7449
Practice Address - Street 1:1300 CARAWAY CT STE 105
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-5462
Practice Address - Country:US
Practice Address - Phone:301-741-3340
Practice Address - Fax:301-925-7449
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2024-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD23930207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB93005Medicare UPIN