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Mary Elizabeth Charleston

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

275 Michigan St NE, Grand Rapids, MI 49503-2531

PECOS Enrollment

This provider is enrolled in PECOS as MARY CHARLESTON.

Based on the most recent information from CMS, provider Mary Elizabeth Charleston is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1083015630
Provider Type
Individual
Full Name
Charleston, Mary Elizabeth
Credential
P.A.-C

Gender
Female
Sole Proprietor
No
Enumeration Date
9/12/2014
Last Updated
12/19/2024

Contact Information

Practice Location

275 Michigan St NE, Grand Rapids, MI 49503-2531

(616) 391-2802

(616) 391-2840

Mailing Location

100 Michigan St NE # Mc845, Grand Rapids, MI 49503-2560

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 5601008287 Michigan

Mary Elizabeth Charleston

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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