Provider Demographics
NPI:1720052210
Name:GUEST, CHARLOTTE J (MD)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:J
Last Name:GUEST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 WEIR DR STE 355
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2273
Mailing Address - Country:US
Mailing Address - Phone:651-254-8580
Mailing Address - Fax:651-730-1700
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:MAIL STOP 11303A
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-4786
Practice Address - Fax:651-228-8362
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN409412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN698318900Medicaid
F35619Medicare UPIN
MN260001812Medicare ID - Type Unspecified