Healthcare Provider Details

I. General information

NPI: 1275731937
Provider Name (Legal Business Name): STEPHANIE M CHARRON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2007
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 JADWICK AVE
RICHLAND WA
99352
US

IV. Provider business mailing address

3900 S ZINTEL WAY
KENNEWICK WA
99337
US

V. Phone/Fax

Practice location:
  • Phone: 509-942-3300
  • Fax: 509-946-1868
Mailing address:
  • Phone: 509-942-3627
  • Fax: 509-942-2268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5636
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60085929
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: