Provider Demographics
NPI:1811777352
Name:CHARBAT, KEN
Entity type:Individual
Prefix:
First Name:KEN
Middle Name:
Last Name:CHARBAT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5523 WOODBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2061
Mailing Address - Country:US
Mailing Address - Phone:937-430-5800
Mailing Address - Fax:
Practice Address - Street 1:5523 WOODBRIDGE LN
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2061
Practice Address - Country:US
Practice Address - Phone:937-430-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRM369429347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle