Provider Demographics
NPI:1962502070
Name:CHARNAM, ROBERT P (DPM)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:CHARNAM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1874 W HILLSBORO BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1420
Mailing Address - Country:US
Mailing Address - Phone:954-426-4544
Mailing Address - Fax:954-426-4533
Practice Address - Street 1:1874 W HILLSBORO BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1420
Practice Address - Country:US
Practice Address - Phone:954-426-4544
Practice Address - Fax:954-426-4533
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1219213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041195700Medicaid
FL041195700Medicaid
FLT95166Medicare UPIN