Provider Demographics
NPI:1588661763
Name:CHARRON, AMY RUBEIS (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:RUBEIS
Last Name:CHARRON
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 1:201 STATE ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16550-0002
Mailing Address - Country:US
Mailing Address - Phone:814-877-6182
Mailing Address - Fax:814-877-6149
Practice Address - Street 1:201 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16550-0002
Practice Address - Country:US
Practice Address - Phone:814-877-6182
Practice Address - Fax:814-877-6149
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4263072085R0202X
NC2016-001392085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA174526OtherUNISON - IMAGING CENTER
PA3962000OtherAETNA
NY02661961OtherNY MEDICAL ASSISTANCE
PA1740380OtherBLUE SHIELD
OH2598989OtherOH MEDICAL ASSISTANCE
PA1013309070001Medicaid
PA707501OtherUPMC
WV1068843OtherW. VIRGINIA WORKERS COMP
PA1545081OtherGATEWAY
PA171898OtherUNISON - HAMOT RADIOLOGY
PAP00244569OtherRR MEDICARE
NY00027280201OtherUNIVERA
PA707501OtherUPMC
PA1013309070001Medicaid