Provider Demographics
NPI:1811014293
Name:CHARLES A. CASARONA, MD
Entity Type:Organization
Organization Name:CHARLES A. CASARONA, MD
Other - Org Name:PEDIATRIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASARONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-756-5137
Mailing Address - Street 1:4900 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-3549
Mailing Address - Country:US
Mailing Address - Phone:334-756-5137
Mailing Address - Fax:334-756-6523
Practice Address - Street 1:4900 20TH AVE
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-3549
Practice Address - Country:US
Practice Address - Phone:334-756-5137
Practice Address - Fax:334-756-6523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16252208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000087234Medicaid
AL009922370Medicaid
AL009922370Medicaid
ALF15709Medicare UPIN