Provider Demographics
NPI:1639529068
Name:SEVERO, CHARLES (PA)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:SEVERO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:112 QUARRY ROAD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4816
Mailing Address - Country:US
Mailing Address - Phone:203-333-8800
Mailing Address - Fax:203-333-6054
Practice Address - Street 1:112 QUARRY ROAD
Practice Address - Street 2:SUITE 400
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4816
Practice Address - Country:US
Practice Address - Phone:203-333-8800
Practice Address - Fax:203-333-6054
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2016-07-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT003579363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant