Provider Demographics
NPI:1083626956
Name:HAVER, CHARLES W (PA-C)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:HAVER
Suffix:
Gender:M
Credentials:PA-C
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 8792
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8792
Mailing Address - Country:US
Mailing Address - Phone:330-626-5566
Mailing Address - Fax:330-626-2402
Practice Address - Street 1:9480 ROSEMONT DR STE 100
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-4569
Practice Address - Country:US
Practice Address - Phone:330-626-5566
Practice Address - Fax:330-626-2402
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-00-1714363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical