Dr CHARLES CHARLES DEFRAIA is a male medical professional, specializing in Internal Medicine. He graduated in 2010 from West Virginia School Of Osteopathic Medicine.
MEETING HOUSE LANE MEDICAL PRACTICE PC
518 MONTAUK HWY
SUITE 102
AMAGANSETT
NY
11930
Tel: 6312675373
| Npi | 1346552536 |
| Pac Id | 0143462739 |
| Professional Enrollment Id | I20130812000080 |
| Last Name | DEFRAIA |
| First Name | CHARLES |
| Middle Name | CHARLES |
| Suffix | |
| Gender | M |
| Credential | |
| Medical School Name | WEST VIRGINIA SCHOOL OF OSTEOPATHIC MEDICINE |
| Graduation Year | 2010 |
| Primary Specialty | INTERNAL MEDICINE |
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| Organization Legal Name | MEETING HOUSE LANE MEDICAL PRACTICE PC |
| Group Practice Pac Id | 6800972589 |
| Number Of Group Practice Members | 88 |
| Line 1 Street Address | 518 MONTAUK HWY |
| Line 2 Street Address | SUITE 102 |
| Marker Of Address Line 2 Suppression | |
| City | AMAGANSETT |
| State | NY |
| Zip Code | 11930 |
| Phone Number | 6312675373 |
| Hospital Affiliation Ccn 1 | 330393 |
| Hospital Affiliation Lbn 1 | SUNY/STONY BROOK UNIVERSITY HOSPITAL |
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| Professional Accepts Medicare Assignment | Y |
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