Provider Demographics
NPI:1871167726
Name:CHARLES, JESSICA (DPM)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1546 PACKER AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-5448
Mailing Address - Country:US
Mailing Address - Phone:215-334-9900
Mailing Address - Fax:215-467-9060
Practice Address - Street 1:1546 PACKER AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-5448
Practice Address - Country:US
Practice Address - Phone:215-334-9900
Practice Address - Fax:215-467-9060
Is Sole Proprietor?:No
Enumeration Date:2021-05-15
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MD00384700213ES0103X
PASC007518213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery