Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | MD454759 | PA |
NPI | 1962793604 |
---|---|
Provider Name | Charelle Monique Carter-Brooks |
First Address | Wilkinsburg, PA 15221-3495 |
Second Address | Washington, DC 20037-3201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2011 |
Last Update Date | 27/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MD454759 | PA LICENSE (01) | PA |