Provider Demographics
NPI:1710170469
Name:MCDYER, CHARLES A JR (RN, BS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:MCDYER
Suffix:JR
Gender:M
Credentials:RN, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:807 LAWN AVENUE
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960
Mailing Address - Country:US
Mailing Address - Phone:215-257-6551
Mailing Address - Fax:267-517-0023
Practice Address - Street 1:807 LAWN AVENUE
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960
Practice Address - Country:US
Practice Address - Phone:215-257-6551
Practice Address - Fax:267-517-0023
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
PARN600126163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator