MEDICARE: DR. SIROTH CHARNOND M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	108377	MO
2	207R00000X	Internal Medicine Physician	036.150546	IL

General Provider Information

NPI Number	:	1265421218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIROTH CHARNOND M.D.

Provider Business Mailing Address
First Line	:	PO BOX 746715
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6715
Country	:	US
Telephone Number	:	314-888-0970
Fax Number	:	314-408-7063

Provider Business Practice Location Address
First Line	:	3451 UNION BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-1142
Country	:	US
Telephone Number	:	314-888-0970
Fax Number	:	314-408-7063

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	03/31/2026

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