Provider Demographics
NPI:1831186840
Name:CHARON, CHRISTOPHER C (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:C
Last Name:CHARON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1858
Mailing Address - Country:US
Mailing Address - Phone:508-791-6305
Mailing Address - Fax:
Practice Address - Street 1:145 POMFRET ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1803
Practice Address - Country:US
Practice Address - Phone:860-928-7330
Practice Address - Fax:860-928-1907
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041543207Y00000X
MA217650207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003119288Medicaid
MA2019892Medicaid
CT003119288Medicaid
MAA35959Medicare ID - Type Unspecified
MA2019892Medicaid