Provider Demographics
NPI:1467550830
Name:GENTILE, CHARON EMILY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARON
Middle Name:EMILY
Last Name:GENTILE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 GABASSE ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4417
Mailing Address - Country:US
Mailing Address - Phone:985-873-7244
Mailing Address - Fax:985-876-2111
Practice Address - Street 1:259 GABASSE ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4417
Practice Address - Country:US
Practice Address - Phone:985-873-7244
Practice Address - Fax:985-876-2111
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL#12368R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1699713Medicaid
LAG54297Medicare UPIN
LA5Y681Medicare PIN