Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 7512 | NH |
NPI | 1003859422 |
---|---|
Provider Name | Edwin L Charle |
First Address | Somersworth, NH 03878-1543 |
Second Address | Somersworth, NH 03878-1543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 29/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
80009241 | (05) | NH |