Provider Demographics
NPI:1215096284
Name:PALMIGIANO, CHARLES C (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:C
Last Name:PALMIGIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:920 NORTHGATE DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3429
Mailing Address - Country:US
Mailing Address - Phone:415-479-1022
Mailing Address - Fax:415-479-5305
Practice Address - Street 1:920 NORTHGATE DR
Practice Address - Street 2:SUITE 6
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3429
Practice Address - Country:US
Practice Address - Phone:415-479-1022
Practice Address - Fax:415-479-5305
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG91390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G91390Medicare ID - Type UnspecifiedMEDICARE PROVIDER
CAA58822Medicare UPIN