Healthcare Provider Details

I. General information

NPI: 1215989322
Provider Name (Legal Business Name): CHARLES J ELDREDGE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BUSINESS PARK DR STE 150
UTICA NY
13502-6322
US

IV. Provider business mailing address

125 BUSINESS PARK DR STE 150
UTICA NY
13502-6322
US

V. Phone/Fax

Practice location:
  • Phone: 315-735-3541
  • Fax: 315-724-3255
Mailing address:
  • Phone: 315-735-3541
  • Fax: 315-724-3255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number165839
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number165839
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: