Provider Demographics
NPI:1457659062
Name:DIPIERRO, CHARLES GIAN (MD, MS, PHD, MPH)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:GIAN
Last Name:DIPIERRO
Suffix:
Gender:M
Credentials:MD, MS, PHD, MPH
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:SUNY STONY BROOK, DEPT. OF PREVENTIVE MEDICINE
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0989
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 NICOLLS RD
Practice Address - Street 2:SUNY STONY BROOK, DEPT. OF PREVENTIVE MEDICINE, HSC L3
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-3902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-06
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052873208D00000X, 2083P0500X
NJ25MA07921600208D00000X, 2083P0500X
NY2645742083P0500X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine