=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982139747
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARITY M LEDBETTER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2017
-----------------------------------------------------
Last Update Date | 04/28/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 245 PAISLEY RD APT. C2
-----------------------------------------------------
City | BALLSTON SPA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12020-2149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-369-9725
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 245 PAISLEY RD APT. C2
-----------------------------------------------------
City | BALLSTON SPA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12020-2149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-369-9725
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 344600000X
-----------------------------------------------------
Taxonomy Name | Taxi
-----------------------------------------------------
License Number | 04693427
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------