Provider Demographics
NPI:1669404059
Name:BAY, CHARLES F (PA)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:F
Last Name:BAY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BARR HARBOR DR FOUR TOWER BRIDGE,
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-6637
Mailing Address - Country:US
Mailing Address - Phone:848-240-2812
Mailing Address - Fax:
Practice Address - Street 1:4503 MAIN ST
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-4447
Practice Address - Country:US
Practice Address - Phone:910-755-5253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
R34518Medicare UPIN
NCNCP674AMedicare UPIN