Healthcare Provider Details

I. General information

NPI: 1982679494
Provider Name (Legal Business Name): GAVIN D CHARTIER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2006
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1813 WILLOW ST # 3B
VINCENNES IN
47591-4276
US

IV. Provider business mailing address

2020 S CLEARVIEW DR
VINCENNES IN
47591-5576
US

V. Phone/Fax

Practice location:
  • Phone: 812-477-7246
  • Fax: 812-477-7240
Mailing address:
  • Phone: 812-886-1151
  • Fax: 812-886-5330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01041179
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number01041179
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: