Provider Demographics
NPI:1356322564
Name:HARRINGTON, CHARLENE (PA)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:HARRINGTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-0304
Mailing Address - Country:US
Mailing Address - Phone:518-747-1041
Mailing Address - Fax:518-747-1022
Practice Address - Street 1:327 BROADWAY
Practice Address - Street 2:FORT EDWARD INTERNAL MEDICINE
Practice Address - City:FORT EDWARD
Practice Address - State:NY
Practice Address - Zip Code:12828-1233
Practice Address - Country:US
Practice Address - Phone:518-747-1041
Practice Address - Fax:518-747-1022
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004799363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00175745OtherRR MEDICARE
NY02284917Medicaid
NYCC5255Medicare PIN
S73590Medicare UPIN