Doctor Name: | DR. CHARLES PRADIEU |
NPI Number: | 1114918778 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 15061 |
Business Practice Address: | 100 S Bliss Ave 100 South Bliss Ave Tahlequah, OK - 744642512 |
Business Phone Number: | 9184583100 |
Business Fax Number: | |
Mailing Address: | 1743 Atherton Ave, 1743 Atherton Ave ELMONT |
State: | NY |
Postal Code: | 110031744 |
Phone Number: | 5164243216 |
Fax Number: | |
NPI Enumeration Date: | 11/02/2005 |
NPI Last Update Date: | 01/10/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 15061 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PR |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |