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NPI Code Detail

MEDICARE: DR. LYSA CHARLES MD

MEDICARE: DR. LYSA CHARLES MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207X00000XOrthopaedic Surgery PhysicianD0053807MD

General Provider Information

NPI Number : 1497832083
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LYSA CHARLES MD
Provider Business Mailing Address
First Line : 2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST
Second Line : KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
City : ROCKVILLE
State : MD
Zip : 20852-4908
Country : US
Telephone Number : 301-816-6660
Fax Number : 301-816-6308
Provider Business Practice Location Address
First Line : 2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST
Second Line : KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
City : ROCKVILLE
State : MD
Zip : 20852-4908
Country : US
Telephone Number : 301-816-6660
Fax Number : 301-816-6308
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 06/03/2021

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