Provider Demographics
NPI:1700376050
Name:ABALOS, CHARMAINE CLARISSE DEQUITO (MD)
Entity Type:Individual
Prefix:MS
First Name:CHARMAINE CLARISSE
Middle Name:DEQUITO
Last Name:ABALOS
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 1:1044 BELMONT AVENUE.
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44501
Mailing Address - Country:US
Mailing Address - Phone:330-480-3196
Mailing Address - Fax:
Practice Address - Street 1:1044 BELMONT AVENUE.
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44501
Practice Address - Country:US
Practice Address - Phone:330-480-3196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-12
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.246176207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine