Provider Demographics
NPI:1235666108
Name:CHARTER PROFESSIONAL GROUP INC
Entity Type:Organization
Organization Name:CHARTER PROFESSIONAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAVITAR
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:CHEEMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-784-1244
Mailing Address - Street 1:775 SUNRISE AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4527
Mailing Address - Country:US
Mailing Address - Phone:916-784-1244
Mailing Address - Fax:916-784-3949
Practice Address - Street 1:775 SUNRISE AVE STE 140
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4527
Practice Address - Country:US
Practice Address - Phone:916-784-1244
Practice Address - Fax:916-784-3949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51362261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center