Provider Demographics
NPI:1720007040
Name:BROOME, CHARLENE BELL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:BELL
Last Name:BROOME
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 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-261-1800
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:6414 U S HIGHWAY 98
Practice Address - Street 2:STE 80
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-7815
Practice Address - Country:US
Practice Address - Phone:601-261-1800
Practice Address - Fax:601-261-1801
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12482208000000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0119222Medicaid
MS030000030Medicare ID - Type Unspecified
MS0119222Medicaid