Healthcare Provider Details

I. General information

NPI: 1780525477
Provider Name (Legal Business Name): MARIE WLADIMIR LOUIS CHARLES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2026
Last Update Date: 04/04/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 P ST NE
WASHINGTON DC
20002-3350
US

IV. Provider business mailing address

40 UPPER ROCK CIR APT 425
ROCKVILLE MD
20850-4487
US

V. Phone/Fax

Practice location:
  • Phone: 202-441-8458
  • Fax:
Mailing address:
  • Phone: 516-405-9199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number748050-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License NumberRN1052894
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN1052894
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: