Provider Demographics
NPI:1972505188
Name:LINDSEY, CHARLES A (PA)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:A
Last Name:LINDSEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6256 ROUTE 41
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077
Mailing Address - Country:US
Mailing Address - Phone:607-273-3161
Mailing Address - Fax:607-273-4979
Practice Address - Street 1:1301 TRUMANSBURG RD
Practice Address - Street 2:STE E
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1397
Practice Address - Country:US
Practice Address - Phone:607-273-3161
Practice Address - Fax:607-273-4979
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003099363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1271434Medicaid
NY1271434Medicaid
NYR54876Medicare UPIN