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NPI Code Detail

MEDICARE: CHARLES P KRONENTHAL JR. PA-C

MEDICARE: CHARLES P KRONENTHAL JR. PA-C
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
1363A00000XPhysician AssistantPA 9104143FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
259-3682760OTHERFLTRI CARE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326017757
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES P KRONENTHAL JR. PA-C
Provider Business Mailing Address
First Line : 14690 SPRING HILL DR STE 305
Second Line :
City : SPRING HILL
State : FL
Zip : 34609-8102
Country : US
Telephone Number : 352-277-5348
Fax Number : 352-606-2857
Provider Business Practice Location Address
First Line : 6279 N LECANTO HWY
Second Line :
City : BEVERLY HILLS
State : FL
Zip : 34465-2503
Country : US
Telephone Number : 352-522-0094
Fax Number : 352-522-0098
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2006
Last Update Date : 07/12/2019

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