Provider Demographics
NPI:1962023747
Name:CHARLES A AMELEMAH SOLE MBR
Entity Type:Organization
Organization Name:CHARLES A AMELEMAH SOLE MBR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR INTERNAL MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:AMELEMAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-573-9078
Mailing Address - Street 1:2443 FM 1488 RD APT 607
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4938
Mailing Address - Country:US
Mailing Address - Phone:832-960-7130
Mailing Address - Fax:832-574-4762
Practice Address - Street 1:837 CYPRESS CREEK PKWY STE 105
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3422
Practice Address - Country:US
Practice Address - Phone:281-453-7158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-03
Last Update Date:2020-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX401831901Medicaid