Provider Demographics
NPI:1437158409
Name:CHARRON, ALBERT EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:EUGENE
Last Name:CHARRON
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 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:5504 PINEBROOK RD
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-3672
Practice Address - Country:US
Practice Address - Phone:941-218-6200
Practice Address - Fax:941-218-6182
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426949207P00000X, 207Q00000X
FLME127208207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA489732OtherBLUE SHIELD
NY00027311601OtherUNIVERA
WV1068852OtherWEST VIRGINIA WORK COMP
PA1546470OtherGATEWAY
PA3953000OtherAETNA
NY02702716OtherNY MEDICAL ASSISTANCE
PA1013438520001Medicaid
NY171877OtherUNISON
PA707502OtherUPMC
OH2581880OtherOH MEDICAL ASSISTANCE
PAP00310036OtherRR MEDICARE
PA1013438520001Medicaid
PA092817E7CMedicare PIN
NY00027311601OtherUNIVERA
PA1546470OtherGATEWAY