1457463275 NPI number — CYNTHIA G CHARNETSKI OD

Table of content: CYNTHIA G CHARNETSKI OD (NPI 1457463275)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457463275 NPI number — CYNTHIA G CHARNETSKI OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHARNETSKI
Provider First Name:
CYNTHIA
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457463275
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 117556
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30368-7556
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-521-2020
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 PEMBROKE DR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILTON HEAD ISLAND
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29926-6200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-785-2525
Provider Business Practice Location Address Fax Number:
843-705-1512
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG000426 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 2499 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001863967 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: D24999 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 817504 . This is a "FIRST PRIORITY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1318122 . This is a "HIGH MARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 83571 . This is a "GEISINGER HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00212048 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 506554 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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