Provider Demographics
NPI:1962466375
Name:CHARROW, JOEL MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:MARTIN
Last Name:CHARROW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:ANN& ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO #59
Mailing Address - Street 2:225 E CHICAGO AVE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-6120
Mailing Address - Fax:312-227-9413
Practice Address - Street 1:ANN& ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO #59
Practice Address - Street 2:225 E CHICAGO AVE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-6120
Practice Address - Fax:312-227-9413
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036055095207SG0202X, 208000000X, 207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No207SG0202XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Biochemical Genetics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036055095Medicaid
C47366Medicare UPIN