Provider Demographics
NPI:1336155506
Name:HOSSEINI, CHARLENE (DO)
Entity type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:
Last Name:HOSSEINI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:6104 KIPPS COLONY DR W
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33707-3970
Mailing Address - Country:US
Mailing Address - Phone:727-341-1553
Mailing Address - Fax:727-507-3618
Practice Address - Street 1:3231 MCMULLEN BOOTH RD
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34694
Practice Address - Country:US
Practice Address - Phone:727-725-6100
Practice Address - Fax:727-725-6118
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS7907207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G69108Medicare UPIN