Provider Demographics
NPI:1740317221
Name:MARK B. CHARBONNET, MD APMC
Entity type:Organization
Organization Name:MARK B. CHARBONNET, MD APMC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:BARTON
Authorized Official - Last Name:CHARBONNET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-560-5510
Mailing Address - Street 1:PO BOX 12109
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70562-2109
Mailing Address - Country:US
Mailing Address - Phone:337-560-5510
Mailing Address - Fax:
Practice Address - Street 1:602 N LEWIS ST
Practice Address - Street 2:SUITE 600
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2093
Practice Address - Country:US
Practice Address - Phone:337-560-5510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL023042207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1490601Medicaid
LA5Y878Medicare PIN
LA1490601Medicaid