Provider Demographics
NPI:1619909249
Name:PARENT, CHARLES A (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:PARENT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:207-604-5085
Mailing Address - Fax:207-282-9180
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:207-604-5085
Practice Address - Fax:207-604-5083
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1565207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME254340099Medicaid
MEMM716502OtherMEDICARE PTAN
MEMM716503Medicare PIN