Healthcare Provider Details

I. General information

NPI: 1144926213
Provider Name (Legal Business Name): CHARLES CARPENTERO MS, CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 BAYBERRY DR
MONROEVILLE PA
15146-1615
US

IV. Provider business mailing address

506 BAYBERRY DR
MONROEVILLE PA
15146-1615
US

V. Phone/Fax

Practice location:
  • Phone: 412-773-2369
  • Fax:
Mailing address:
  • Phone: 412-654-1999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberCNS-19125
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: