MEDICARE: MARSHA CHARLES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247200000X	Other Technician

General Provider Information

NPI Number	:	1619482411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSHA CHARLES

Provider Business Mailing Address
First Line	:	7908 SW 8TH ST
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-2133
Country	:	US
Telephone Number	:	904-520-8877
Fax Number	:

Provider Business Practice Location Address
First Line	:	7908 SW 8TH ST
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-2133
Country	:	US
Telephone Number	:	904-520-8877
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2017
Last Update Date	:	12/04/2017

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Directions to “ MARSHA CHARLES ” Practice Location

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