| Paul S. Charnetsky, M.d. P.c. | |
|
13851 W La Mar Blvd Suite B Goodyear AZ 85338-1389 | |
| (623) 932-2200 | |
| (623) 932-2242 |
| Full Name | Paul S. Charnetsky, M.d. P.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 13851 W La Mar Blvd, Goodyear, Arizona |
| Authorized Official Name and Position | Paul Scott Charnetsky (OWNER) |
| Authorized Official Contact | 6239322200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Paul S. Charnetsky, M.d. P.c. 13851 W La Mar Blvd Suite B Goodyear AZ 85338-1389 Ph: (623) 932-2200 | Paul S. Charnetsky, M.d. P.c. 13851 W La Mar Blvd Suite B Goodyear AZ 85338-1389 Ph: (623) 932-2200 |
| NPI Number | 1982623542 |
|---|---|
| Provider Enumeration Date | 07/18/2006 |
| Last Update Date | 04/20/2008 |
| Medicare PECOS PAC ID | 7618933227 |
|---|---|
| Medicare Enrollment ID | O20041206000771 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982623542 | NPI | - | NPPES |
| 20645 | Other | AZ | AZ STATE LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 20645 (Arizona) | Primary |
| 2080A0000X | Pediatrics - Adolescent Medicine | 20645 (Arizona) | Secondary |
| Provider Name | Paul S Charnetsky |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477515021 PECOS PAC ID: 3870559487 Enrollment ID: I20041207000453 |
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