Basic Information
| Provider Information | |||||||||
| NPI: | 1265421218 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHARNOND | ||||||||
| FirstName: | SIROTH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 740019 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303740019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3127339730 | ||||||||
| FaxNumber: | 7738668014 | ||||||||
| Practice Location | |||||||||
| Address1: | 7421 S OUTER 364 | ||||||||
| Address2: | |||||||||
| City: | DARDENNE PRAIRIE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633687014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6365618100 | ||||||||
| FaxNumber: | 6365613396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2005 | ||||||||
| LastUpdateDate: | 01/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 108377 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.