Provider Demographics
NPI:1548381965
Name:MORGAN, CHARLENE ELSTON (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:ELSTON
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:13339 POINT RIDER LN
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-3813
Mailing Address - Country:US
Mailing Address - Phone:703-709-6942
Mailing Address - Fax:
Practice Address - Street 1:610 PROFESSIONAL DR
Practice Address - Street 2:SUITE 255
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3413
Practice Address - Country:US
Practice Address - Phone:240-683-6202
Practice Address - Fax:240-683-6202
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DC99363AM0700X
MDC0004727363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical