Provider Demographics
NPI:1376616276
Name:YARNEVICH, CHARLES S (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:S
Last Name:YARNEVICH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1548 FULTON RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44703
Mailing Address - Country:US
Mailing Address - Phone:330-454-6082
Mailing Address - Fax:330-454-5582
Practice Address - Street 1:1548 FULTON RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44703
Practice Address - Country:US
Practice Address - Phone:330-454-6082
Practice Address - Fax:330-454-5582
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001538Y213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0176849Medicaid
T80350Medicare UPIN
OH0176849Medicaid