Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | S01301 | MD |
NPI | 1265484547 |
---|---|
Provider Name | Samuel G Charles |
First Address | Elkton, MD 21921-5932 |
Second Address | Elkton, MD 21921-5932 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 19/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T59540 | (02) |