Provider Demographics
NPI:1538143433
Name:CHARLOTTEN, KEVIN ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ALEXANDER
Last Name:CHARLOTTEN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4150 78TH ST
Mailing Address - Street 2:SUITE 102/103
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1950
Mailing Address - Country:US
Mailing Address - Phone:718-606-0187
Mailing Address - Fax:718-606-0958
Practice Address - Street 1:4150 78TH ST STE 102103
Practice Address - Street 2:Q-CARE AFFORDABLE MEDICAL CARE, PLLC
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1950
Practice Address - Country:US
Practice Address - Phone:718-606-0187
Practice Address - Fax:718-606-0958
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2011-04-26
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Provider Licenses
StateLicense IDTaxonomies
NY221293207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02230353Medicaid
NYH89019Medicare UPIN
NY73V141Medicare PIN