Provider Demographics
NPI:1982139747
Name:LEDBETTER, CHARITY M
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:M
Last Name:LEDBETTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 PAISLEY RD
Mailing Address - Street 2:APT. C2
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-2149
Mailing Address - Country:US
Mailing Address - Phone:518-369-9725
Mailing Address - Fax:
Practice Address - Street 1:245 PAISLEY RD
Practice Address - Street 2:APT. C2
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-2149
Practice Address - Country:US
Practice Address - Phone:518-369-9725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04693427344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04693427Medicaid