Provider Demographics
NPI:1366310757
Name:ST. CHARLES, JUSTIN PAUL
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:PAUL
Last Name:ST. CHARLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24083-3608
Mailing Address - Country:US
Mailing Address - Phone:540-798-9215
Mailing Address - Fax:
Practice Address - Street 1:49 VILLAGE LN
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24083-3608
Practice Address - Country:US
Practice Address - Phone:540-798-9215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver