Individual
MARK J CHARLAMB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
510 TOWNE DR, FAYETTEVILLE, NY 13066-1331
(315) 663-0500
(315) 663-0514
Mailing address
510 TOWNE DR, FAYETTEVILLE, NY 13066-1331
(315) 663-0500
(315) 663-0514
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
192142
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01816926
—
NY
Enumeration date
07/12/2005
Last updated
10/01/2019
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