Provider Demographics
NPI:1750362539
Name:CHARNITSKY, SCOTT E (PAC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:E
Last Name:CHARNITSKY
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7707 FANNIN
Mailing Address - Street 2:SUITE 195
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054
Mailing Address - Country:US
Mailing Address - Phone:713-797-0045
Mailing Address - Fax:713-797-1821
Practice Address - Street 1:7707 FANNIN
Practice Address - Street 2:SUITE 195
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054
Practice Address - Country:US
Practice Address - Phone:713-797-0045
Practice Address - Fax:713-797-1821
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000970363AM0700X
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
230590OtherPREFERRED ONE
290000970CT01OtherBLUE CROSS
2V3628OtherHEALTHNET MEDICAID
2V3628OtherHEALTHNET
090970OtherCONNECTICARE