MEDICARE: VANESSA S CHARETTE MD

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	208000000X	Pediatrics Physician	L3940	TX

General Provider Information

NPI Number	:	1851405534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA S CHARETTE MD

Provider Business Mailing Address
First Line	:	PO BOX 733784
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75373-3784
Country	:	US
Telephone Number	:	682-885-1855
Fax Number	:	682-885-1396

Provider Business Practice Location Address
First Line	:	1263 W ROSEDALE ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2830
Country	:	US
Telephone Number	:	817-336-4896
Fax Number	:	817-332-2805

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	05/12/2021

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