MEDICARE: CHARLES A PRENTICE MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME38475	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013293109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES A PRENTICE MD PA

Provider Business Mailing Address
First Line	:	214 S PINE AVE
Second Line	:
City	:	INVERNESS
State	:	FL
Zip	:	34452-4838
Country	:	US
Telephone Number	:	352-726-9006
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 S PINE AVE
Second Line	:
City	:	INVERNESS
State	:	FL
Zip	:	34452-4838
Country	:	US
Telephone Number	:	352-726-9006
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	CHARLES ALEXANDER PRENTICE
Credential	:	MD
Telephone Number	:	352-726-9006

Provider Enumeration Date	:	11/02/2011
Last Update Date	:	11/15/2011

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Directions to “CHARLES A PRENTICE MD PA ” Practice Location

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