Provider Demographics
NPI:1265288468
Name:CHARLES, MARSHALA M
Entity type:Individual
Prefix:MRS
First Name:MARSHALA
Middle Name:M
Last Name:CHARLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 E 98TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5321
Mailing Address - Country:US
Mailing Address - Phone:917-335-5369
Mailing Address - Fax:347-405-5796
Practice Address - Street 1:1519 E 98TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5321
Practice Address - Country:US
Practice Address - Phone:917-335-5369
Practice Address - Fax:347-405-5796
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor