Individual
MEDITH CODIO CHARLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1102 W SOMERVILLE AVE, PHILADELPHIA, PA 19141-2904
(267) 304-6775
Mailing address
1102 W SOMERVILLE AVE, PHILADELPHIA, PA 19141-2904
(267) 304-6775
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN279465
PA
Other
Enumeration date
02/13/2024
Last updated
02/19/2024
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