Provider Demographics
NPI:1679026983
Name:CHARLOT, CANTAVE (MD)
Entity Type:Individual
Prefix:DR
First Name:CANTAVE
Middle Name:
Last Name:CHARLOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E ELM ST APT 3G
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-2976
Mailing Address - Country:US
Mailing Address - Phone:732-481-9442
Mailing Address - Fax:
Practice Address - Street 1:1200 NE 125TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5936
Practice Address - Country:US
Practice Address - Phone:305-685-5688
Practice Address - Fax:305-688-7995
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN888208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty