Provider Demographics
NPI:1982647129
Name:ANDREWS, CHARLENE A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:A
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:16995 137TH AVE
Mailing Address - Street 2:#19
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-4517
Mailing Address - Country:US
Mailing Address - Phone:718-528-1503
Mailing Address - Fax:718-528-1501
Practice Address - Street 1:16995 137TH AVE
Practice Address - Street 2:#19
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-4517
Practice Address - Country:US
Practice Address - Phone:718-528-1503
Practice Address - Fax:718-528-1501
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY235994207R00000X
NY235994-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI34273Medicare UPIN
NY9255SCMedicare ID - Type Unspecified