Provider Demographics
NPI:1093761835
Name:CHARLOTTE FAMILY HEALTH CENTER INC
Entity type:Organization
Organization Name:CHARLOTTE FAMILY HEALTH CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:VB
Authorized Official - Last Name:REGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-425-2781
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:VT
Mailing Address - Zip Code:05445-0038
Mailing Address - Country:US
Mailing Address - Phone:802-425-2781
Mailing Address - Fax:
Practice Address - Street 1:527 FERRY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:VT
Practice Address - Zip Code:05445-9555
Practice Address - Country:US
Practice Address - Phone:802-425-2781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN1113Medicaid
VT0VN1113Medicaid