Provider Demographics
NPI:1487184701
Name:MCGLADE, CHARLES (MSN, APN)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:MCGLADE
Suffix:
Gender:M
Credentials:MSN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 GRANGE CT
Mailing Address - Street 2:
Mailing Address - City:WOODSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08098-1253
Mailing Address - Country:US
Mailing Address - Phone:856-649-6101
Mailing Address - Fax:
Practice Address - Street 1:201 TOMLIN STATION RD
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-1612
Practice Address - Country:US
Practice Address - Phone:856-241-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00718400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily