Healthcare Provider Details

I. General information

NPI: 1902807282
Provider Name (Legal Business Name): CHARLES HUGHES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 JEFFERSON AVE STE 104
SCRANTON PA
18510-1636
US

IV. Provider business mailing address

610 WYOMING AVE
KINGSTON PA
18704-3702
US

V. Phone/Fax

Practice location:
  • Phone: 570-344-9457
  • Fax: 570-343-3731
Mailing address:
  • Phone: 570-288-5441
  • Fax: 570-288-5842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD048367L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA06215200
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberMD048367L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0016668600008
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: