Provider Demographics
NPI:1982623542
Name:PAUL S. CHARNETSKY, M.D. P.C.
Entity type:Organization
Organization Name:PAUL S. CHARNETSKY, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CHARNETSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-932-2200
Mailing Address - Street 1:13851 W LA MAR BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1389
Mailing Address - Country:US
Mailing Address - Phone:623-932-2200
Mailing Address - Fax:623-932-2242
Practice Address - Street 1:13851 W LA MAR BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1389
Practice Address - Country:US
Practice Address - Phone:623-932-2200
Practice Address - Fax:623-932-2242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ206452080A0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ20645OtherAZ STATE LICENSE
AZ=========OtherTAX ID NUMBER
AZF53784Medicare UPIN
AZ=========OtherTAX ID NUMBER