Provider Demographics
NPI:1407930092
Name:CHARLES, ERIC LUKAS (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:LUKAS
Last Name:CHARLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LUKAS
Other - Middle Name:
Other - Last Name:CHARLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 52788
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-2788
Mailing Address - Country:US
Mailing Address - Phone:865-766-8800
Mailing Address - Fax:865-766-8874
Practice Address - Street 1:100 E 77TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-1850
Practice Address - Country:US
Practice Address - Phone:212-434-2685
Practice Address - Fax:212-434-5523
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1502492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02269607Medicaid
NJ0542407Medicaid
NY689S31OtherEMPIRE BCBS
NY523S1TG231Medicare PIN
NY689S31OtherEMPIRE BCBS
NY02269607Medicaid
NY523S11Medicare PIN