Healthcare Provider Details

I. General information

NPI: 1073572236
Provider Name (Legal Business Name): CHARLES H RHEEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 09/19/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

658 MALTA AVE STE 101
MALTA NY
12020
US

IV. Provider business mailing address

658 MALTA AVE STE 101
MALTA NY
12020
US

V. Phone/Fax

Practice location:
  • Phone: 518-580-0553
  • Fax: 518-580-0557
Mailing address:
  • Phone: 518-580-0553
  • Fax: 518-580-0557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number207362
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number207362-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: