Healthcare Provider Details

I. General information

NPI: 1306819206
Provider Name (Legal Business Name): CHARLES W SWEENEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 OVERSEAS HWY
MARATHON FL
33050-2329
US

IV. Provider business mailing address

PO BOX 403208
ATLANTA GA
30384-3208
US

V. Phone/Fax

Practice location:
  • Phone: 305-743-5533
  • Fax: 305-289-0630
Mailing address:
  • Phone: 800-377-8721
  • Fax: 304-523-2241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME59785
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: