Provider Demographics
NPI:1255446894
Name:AGNONE, CHARLOTTE MARIE (MD FACS)
Entity type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:MARIE
Last Name:AGNONE
Suffix:
Gender:F
Credentials:MD FACS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:114 MOREY DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040
Mailing Address - Country:US
Mailing Address - Phone:937-578-2200
Mailing Address - Fax:937-578-4089
Practice Address - Street 1:114 MOREY DRIVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040
Practice Address - Country:US
Practice Address - Phone:937-578-2200
Practice Address - Fax:937-578-4089
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062148A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0862222Medicaid
F07895Medicare UPIN
OH0862222Medicaid