Provider Demographics
NPI:1073628491
Name:CHARNECO, JERRY CHARLES (MD)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:CHARLES
Last Name:CHARNECO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 194800
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-4800
Mailing Address - Country:US
Mailing Address - Phone:787-850-7900
Mailing Address - Fax:
Practice Address - Street 1:63 CALLE MUNOZ MARIN
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3646
Practice Address - Country:US
Practice Address - Phone:787-850-7900
Practice Address - Fax:787-850-7900
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4249207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR96967Medicare ID - Type Unspecified
PRE31150Medicare UPIN