Provider Demographics
NPI:1811044225
Name:CHARLES, EDGAR DAVDISON III (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:DAVDISON
Last Name:CHARLES
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 YORK AVE
Mailing Address - Street 2:BOX 64
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-6307
Mailing Address - Country:US
Mailing Address - Phone:212-327-7068
Mailing Address - Fax:
Practice Address - Street 1:1230 YORK AVE
Practice Address - Street 2:BOX 64
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-6307
Practice Address - Country:US
Practice Address - Phone:212-327-7068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220074207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease