Provider Demographics
NPI:1982816153
Name:CHARLES EATON MD PA
Entity Type:Organization
Organization Name:CHARLES EATON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EATON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-746-7686
Mailing Address - Street 1:4020 S 57TH AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-4302
Mailing Address - Country:US
Mailing Address - Phone:561-432-5035
Mailing Address - Fax:561-828-0895
Practice Address - Street 1:1002 S. OLD DIXIE HIGHWAY
Practice Address - Street 2:SUITE 105
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:561-746-7686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053188207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15048AMedicare PIN
FLP00414727Medicare PIN
FLF09623Medicare UPIN
FLAC576Medicare PIN