Healthcare Provider Details

I. General information

NPI: 1225513997
Provider Name (Legal Business Name): CLAIRE L CHARLES CRNP-FAMILY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLAIRE L CHARLES NP-C

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6535 N CHARLES ST STE 400N
BALTIMORE MD
21204-5826
US

IV. Provider business mailing address

6535 N CHARLES ST STE 400N
TOWSON MD
21204-5826
US

V. Phone/Fax

Practice location:
  • Phone: 561-633-7416
  • Fax:
Mailing address:
  • Phone: 410-828-7417
  • Fax: 410-828-4695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR212623
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: