MEDICARE: CHARLES V. PIERMARINI PA-C

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	363AM0700X	Medical Physician Assistant	6072	AZ
2	363A00000X	Physician Assistant	6072	AZ

General Provider Information

NPI Number	:	1881076354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES V. PIERMARINI PA-C

Provider Business Mailing Address
First Line	:	8939 W HARMONY LN
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-2403
Country	:	US
Telephone Number	:	480-697-2727
Fax Number	:

Provider Business Practice Location Address
First Line	:	6036 N 19TH AVE STE 204
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-2104
Country	:	US
Telephone Number	:	480-616-0356
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2015
Last Update Date	:	04/16/2025

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