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NPI Code Detail

MEDICARE: MARY C CHARLES CNP

MEDICARE: MARY C CHARLES CNP
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
1363LG0600XGerontology Nurse PractitionerAPRN.CNP.16583OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790187607
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY C CHARLES CNP
Provider Business Mailing Address
First Line : 1407 MULFORD RD
Second Line :
City : COLUMBUS
State : OH
Zip : 43212-3404
Country : US
Telephone Number : 614-226-5469
Fax Number :
Provider Business Practice Location Address
First Line : 420 N JAMES RD
Second Line :
City : COLUMBUS
State : OH
Zip : 43219-1834
Country : US
Telephone Number : 614-257-5200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2014
Last Update Date : 02/24/2026

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