Provider Demographics
NPI:1437137353
Name:VARGAS, CHARLENE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:
Last Name:VARGAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHARLENE
Other - Middle Name:FRANI
Other - Last Name:MIRANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1653 JESS PARRISH CT
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2145
Mailing Address - Country:US
Mailing Address - Phone:321-267-5965
Mailing Address - Fax:321-267-8487
Practice Address - Street 1:1653 JESS PARRISH CT
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2145
Practice Address - Country:US
Practice Address - Phone:321-267-5965
Practice Address - Fax:321-267-8487
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1005132080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280554500Medicaid
123067OtherNATIONWIDE
8495401OtherHUMANA
1205165OtherUNITED HEALTH CARE
000000392792OtherANTHEM
OH2536509Medicaid
7937577OtherETNA
8495401OtherHUMANA
OH2536509Medicaid