Provider Demographics
NPI:1215989322
Name:ELDREDGE, CHARLES J (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:ELDREDGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 BUSINESS PARK DR STE 150
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6322
Mailing Address - Country:US
Mailing Address - Phone:315-735-3541
Mailing Address - Fax:315-724-3255
Practice Address - Street 1:125 BUSINESS PARK DR STE 150
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-6322
Practice Address - Country:US
Practice Address - Phone:315-735-3541
Practice Address - Fax:315-724-3255
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165839207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01070199Medicaid
NYRA3053Medicare PIN
NYB82812Medicare UPIN
NY01070199Medicaid