Provider Demographics
NPI:1790120822
Name:CHARLES, CATHY-ANNE MARIA (MD)
Entity Type:Individual
Prefix:
First Name:CATHY-ANNE
Middle Name:MARIA
Last Name:CHARLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-1704
Mailing Address - Country:US
Mailing Address - Phone:917-407-3367
Mailing Address - Fax:631-269-1092
Practice Address - Street 1:327 BEACH 19TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4423
Practice Address - Country:US
Practice Address - Phone:718-869-7108
Practice Address - Fax:631-269-1092
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-01477207Q00000X
NY292750207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine