Healthcare Provider Details

I. General information

NPI: 1720117195
Provider Name (Legal Business Name): MARK LEON CHARPENTIER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2007
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1373 E STATE ROAD 62
MADISON IN
47250-7328
US

IV. Provider business mailing address

4132 ANDREW DR
FLOYDS KNOBS IN
47119-9364
US

V. Phone/Fax

Practice location:
  • Phone: 812-801-0152
  • Fax: 812-801-0150
Mailing address:
  • Phone: 502-558-5990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01058005A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01058005A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number01058005A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number01058005A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: