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General NPI Number Information
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NPI Number | 1538143433
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Entity Type | Individual
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Provider Name | KEVIN ALEXANDER CHARLOTTEN MD
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Gender | Male
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Dates
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Enumeration Date | 12/05/2005
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 4150 78TH ST STE 102103 Q-CARE AFFORDABLE MEDICAL CARE, PLLC
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City | ELMHURST
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State | NY
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Zip | 11373-1950
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Country | US
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Telephone | 718-606-0187
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Fax | 718-606-0958
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Provider Business Mailing Address
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Address Line | 4150 78TH ST SUITE 102/103
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City | ELMHURST
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State | NY
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Zip | 11373-1950
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Country | US
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Telephone | 718-606-0187
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Fax | 718-606-0958
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 221293
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License Number State | NY
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