Provider Demographics
NPI:1588629216
Name:CHARLES, RICHARD EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EDWARD
Last Name:CHARLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6255 SHERIDAN DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4836
Mailing Address - Country:US
Mailing Address - Phone:716-857-8666
Mailing Address - Fax:716-857-8944
Practice Address - Street 1:85 HIGH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1149
Practice Address - Country:US
Practice Address - Phone:716-857-8641
Practice Address - Fax:716-856-3002
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY213322207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00020553501OtherUNIVERA
NY161000580OtherEMPIRE
NY000525766003OtherHEALTH NOW
NY0410829OtherIHA
NY213322-1WOtherWORKERS COMPENSATION
NY161000580OtherNORTH AMERICAN PREFERRED
NY01991868Medicaid
NY00020553501OtherUNIVERA
NY0410829OtherIHA