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General NPI Number Information
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NPI Number | 1588701700
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Entity Type | Individual
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Provider Name | CHARLES JAMES MCCLUSKEY PA
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Gender | Male
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 02/27/2013
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Provider Practice Location Address
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Address Line | 6500 66TH ST
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City | PINELLAS PARK
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State | FL
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Zip | 33781-5030
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Country | US
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Telephone | 727-347-1286
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Fax | 727-345-3084
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Provider Business Mailing Address
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Address Line | 6500 66TH STREET NORTH
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City | PINELLAS PARK
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State | FL
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Zip | 33704-3537
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Country | US
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Telephone | 727-347-1286
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Fax | 727-384-8224
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA1840
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License Number State | FL
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