Provider Demographics
NPI:1386696813
Name:CHARLAMB, JAYNE R (MD)
Entity type:Individual
Prefix:
First Name:JAYNE
Middle Name:R
Last Name:CHARLAMB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAYE
Other - Middle Name:
Other - Last Name:RUBENSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:90 PRESIDENTIAL PLZ
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-2240
Mailing Address - Country:US
Mailing Address - Phone:315-464-8224
Mailing Address - Fax:315-464-2187
Practice Address - Street 1:90 PRESIDENTIAL PLZ
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2240
Practice Address - Country:US
Practice Address - Phone:315-464-8224
Practice Address - Fax:315-464-2187
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209538207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02136309Medicaid
NY02136309Medicaid