Provider Demographics
NPI:1861482986
Name:WILES, CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:WILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:462 GRIDER ST
Mailing Address - Street 2:DK MILLER BUILDING
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3021
Mailing Address - Country:US
Mailing Address - Phone:716-898-5186
Mailing Address - Fax:716-898-3194
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:DK MILLER BUILDING MILLER BLDG.
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-5103
Practice Address - Fax:716-898-3194
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD00242852086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03037203Medicaid
J400001058Medicare PIN