Provider Demographics
NPI:1376686048
Name:GIANNASIO, CHARLES V (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:V
Last Name:GIANNASIO
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 1:900 LENMAR DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-2000
Mailing Address - Country:US
Mailing Address - Phone:215-643-1135
Mailing Address - Fax:
Practice Address - Street 1:900 LENMAR DR
Practice Address - Street 2:SUITE B
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2000
Practice Address - Country:US
Practice Address - Phone:215-643-1135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016980E2084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA0551123Medicaid
PAB36200Medicare UPIN
PAGI95044Medicare ID - Type Unspecified