Provider Demographics
NPI:1407819410
Name:CHARON, BONNIE J (PA-C)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:J
Last Name:CHARON
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:114 OVERBROOK RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-1713
Mailing Address - Country:US
Mailing Address - Phone:410-372-0073
Mailing Address - Fax:410-605-7914
Practice Address - Street 1:10 N GREENE ST
Practice Address - Street 2:ROOM 5D 149
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1524
Practice Address - Country:US
Practice Address - Phone:410-605-7000
Practice Address - Fax:410-605-7914
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0000777363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical