Provider Demographics
NPI:1578854667
Name:CHARLES A PARENT DO PA
Entity Type:Organization
Organization Name:CHARLES A PARENT DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:PARENT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-251-1079
Mailing Address - Street 1:24 PORTLAND RD
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6747
Mailing Address - Country:US
Mailing Address - Phone:207-251-1079
Mailing Address - Fax:207-967-9151
Practice Address - Street 1:24 PORTLAND RD
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6747
Practice Address - Country:US
Practice Address - Phone:207-251-1079
Practice Address - Fax:207-967-9151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1565207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty