MEDICARE: DR. MARGARET CHARITY CHARMOLI PHD

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	103TC1900X	Counseling Psychologist	LP1479	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	932761001632	OTHER	MN	PREFERRED ONE PIN
2	00Q54CH	OTHER	MN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1730239278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARGARET CHARITY CHARMOLI PHD

Provider Business Mailing Address
First Line	:	570 ASBURY STREET
Second Line	:	SUITE 202A
City	:	ST PAUL
State	:	MN
Zip	:	55104-1850
Country	:	US
Telephone Number	:	651-645-5588
Fax Number	:	651-642-9851

Provider Business Practice Location Address
First Line	:	570 ASBURY STREET
Second Line	:	SUITE 202A
City	:	ST PAUL
State	:	MN
Zip	:	55104-1850
Country	:	US
Telephone Number	:	651-645-5588
Fax Number	:	651-642-9851

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2007

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