Provider Demographics
NPI:1932226040
Name:ST JAMES, CHARLES (BC HIS)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:ST JAMES
Suffix:
Gender:M
Credentials:BC HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 ARSENAL STREET
Mailing Address - Street 2:SUITE 502
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601
Mailing Address - Country:US
Mailing Address - Phone:315-785-8310
Mailing Address - Fax:315-785-8338
Practice Address - Street 1:1116 ARSENAL STREET
Practice Address - Street 2:SUITE 502
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:315-785-8310
Practice Address - Fax:315-785-8338
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000004569237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP21450OtherGHI FHP
NY55283BMedicare ID - Type Unspecified
NY55283AMedicare ID - Type Unspecified