Provider Demographics
NPI:1760683833
Name:CHARLES, CARLOS ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:ALBERTO
Last Name:CHARLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:155 CRYSTAL RUN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-4057
Mailing Address - Country:US
Mailing Address - Phone:845-703-6999
Mailing Address - Fax:845-703-6297
Practice Address - Street 1:61 EMERALD PL
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:NY
Practice Address - Zip Code:12775-6049
Practice Address - Country:US
Practice Address - Phone:845-794-6999
Practice Address - Fax:845-703-6297
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2020-08-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY220104207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100090336Medicare PIN
NYA400005772Medicare PIN