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General NPI Number Information
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NPI Number | 1013159508
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Entity Type | Individual
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Provider Name | MOLLIE A CHARON MD
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Gender | Female
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Dates
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Enumeration Date | 03/30/2009
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Last Update Date | 12/22/2021
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Provider Practice Location Address
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Address Line | 530 WI DELLS PARKWAY SOUTH
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City | LAKE DELTON
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State | WI
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Zip | 53940
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Country | US
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Telephone | 608-254-5400
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Fax | 608-253-8585
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Provider Business Mailing Address
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Address Line | 530 WI DELLS PARKWAY SOUTH
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City | LAKE DELTON
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State | WI
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Zip | 53940
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Country | US
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Telephone | 608-254-5400
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Fax | 608-253-8585
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 64472-20
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License Number State | WI
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