Provider Demographics
NPI:1568439404
Name:CHARITY, JENNIFER A (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:CHARITY
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 1:1111 12TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4084
Mailing Address - Country:US
Mailing Address - Phone:305-295-3535
Mailing Address - Fax:305-294-6868
Practice Address - Street 1:1111 12TH ST STE 103
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4084
Practice Address - Country:US
Practice Address - Phone:305-295-3535
Practice Address - Fax:305-294-6868
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016395207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME248590099Medicaid
H99660Medicare UPIN
ME248590099Medicaid