Park, Charles

Park, Charles is an individual health care provider with primary practice located at 150 Sargent Dr Suite 1, New Haven CT 06511-6100. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Park, Charles can be contacted via phone (203) 781-4444.

Contact Information

Primary practice address
150 Sargent Dr Suite 1 New Haven CT 06511-6100
Phone: (203) 781-4444
Fax: (203) 789-8341
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 000001 Connecticut

Profile Details

NPI number 1215928072
LBN Legal business name Park, Charles
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 2nd, 2005
Last updated Dec 8th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215928072 NPPES
Connecticut Other 970011498 RAILROAD MEDICARE

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