Provider Demographics
NPI:1104088681
Name:ALAN CHARNELLE MD
Entity type:Organization
Organization Name:ALAN CHARNELLE MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARNELLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-892-4301
Mailing Address - Street 1:9561 VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-1344
Mailing Address - Country:US
Mailing Address - Phone:818-892-4301
Mailing Address - Fax:818-891-7996
Practice Address - Street 1:9561 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-1344
Practice Address - Country:US
Practice Address - Phone:818-892-4301
Practice Address - Fax:818-891-7996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center