Provider Demographics
NPI:1740356971
Name:LAMARCA, CHARLES ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ANTHONY
Last Name:LAMARCA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7506 ELIOT AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-1207
Mailing Address - Country:US
Mailing Address - Phone:718-335-2224
Mailing Address - Fax:718-898-9798
Practice Address - Street 1:7506 ELIOT AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1207
Practice Address - Country:US
Practice Address - Phone:718-335-2224
Practice Address - Fax:718-898-9798
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133916174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2147085OtherAETNA
NY1C6469OtherHEALTH NET
NY0032030OtherGHI
NYDS569OtherOXFORD
NY77A671OtherEMPIRE HEALTHCHOICE
NYB19289Medicare UPIN
NY2147085OtherAETNA