Provider Demographics
NPI:1457344772
Name:SANIOUR, CHARLES ELIAS (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ELIAS
Last Name:SANIOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5307 MAIN ST
Mailing Address - Street 2:STE 102
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-2536
Mailing Address - Country:US
Mailing Address - Phone:727-847-3733
Mailing Address - Fax:727-841-0384
Practice Address - Street 1:5307 MAIN ST
Practice Address - Street 2:STE 102
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-2536
Practice Address - Country:US
Practice Address - Phone:727-847-3733
Practice Address - Fax:727-841-0384
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53945207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL04000Medicare ID - Type Unspecified
H50727Medicare UPIN