Individual provider · Type 1 NPI

Charles Walter Southard

Student in an Organized Health Care Education/Training Program · Riverhead, NY

NPI number 1346047388 Active

Practice location

400 W Main St
Riverhead, NY 11901-2813

Call (631) 369-0104 Map

Mailing address

18 Forest Ln
Coram, NY 11727-3139

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1346047388

Charles Walter Southard's National Provider Identifier is 1346047388, issued on Feb 27, 2025. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Riverhead, NY. The record was last updated on Feb 27, 2025.