Provider Demographics
NPI:1609403096
Name:SWEET, CHARLES SPOONER (NATIONALLY REGISTERE)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:SPOONER
Last Name:SWEET
Suffix:
Gender:M
Credentials:NATIONALLY REGISTERE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 BALDWIN STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1503
Mailing Address - Country:US
Mailing Address - Phone:508-649-6697
Mailing Address - Fax:
Practice Address - Street 1:28 BALDWIN STREET
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1503
Practice Address - Country:US
Practice Address - Phone:508-649-6697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAP0903270146L00000X
RIEMT15246-P146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic