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General NPI Number Information
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NPI Number | 1578854667
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Entity Type | Organization
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Legal Business Name | CHARLES A PARENT DO PA
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Dates
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Enumeration Date | 04/25/2011
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Last Update Date | 04/25/2011
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Provider Practice Location Address
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Address Line | 24 PORTLAND RD
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City | KENNEBUNK
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State | ME
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Zip | 04043-6747
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Country | US
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Telephone | 207-251-1079
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Fax | 207-967-9151
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Provider Business Mailing Address
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Address Line | 24 PORTLAND RD
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City | KENNEBUNK
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State | ME
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Zip | 04043-6747
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Country | US
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Telephone | 207-251-1079
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Fax | 207-967-9151
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | DR. CHARLES A PARENT
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Credential | DO
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Telephone | 207-251-1079
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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 | 1565
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License Number State | ME
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