Provider Demographics
NPI:1891718177
Name:CHARBONNET, MARK BARTON (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:BARTON
Last Name:CHARBONNET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 12109
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70562-2109
Mailing Address - Country:US
Mailing Address - Phone:337-560-5510
Mailing Address - Fax:337-560-5554
Practice Address - Street 1:602 N LEWIS ST
Practice Address - Street 2:SUITE 600
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2093
Practice Address - Country:US
Practice Address - Phone:337-560-5510
Practice Address - Fax:337-560-5554
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA023042207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1490601Medicaid
LA1490601Medicaid
LAG60621Medicare UPIN