Basic Information
| Provider Information | |||||||||
| NPI: | 1588661763 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHARRON | ||||||||
| FirstName: | AMY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 STATE ST | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165500002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148776182 | ||||||||
| FaxNumber: | 8148776149 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 STATE ST | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165500002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148776182 | ||||||||
| FaxNumber: | 8148776149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2005 | ||||||||
| LastUpdateDate: | 03/19/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD426307 | PA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1740380 | 01 | PA | BLUE SHIELD | OTHER | 174526 | 01 | PA | UNISON - IMAGING CENTER | OTHER | 707501 | 01 | PA | UPMC | OTHER | 171898 | 01 | PA | UNISON - HAMOT RADIOLOGY | OTHER | 1013309070001 | 05 | PA | MEDICAID | 1545081 | 01 | PA | GATEWAY | OTHER | 2598989 | 01 | OH | OH MEDICAL ASSISTANCE | OTHER | 02661961 | 01 | NY | NY MEDICAL ASSISTANCE | OTHER | P00244569 | 01 | PA | RR MEDICARE | OTHER | 00027280201 | 01 | NY | UNIVERA | OTHER | 3962000 | 01 | PA | AETNA | OTHER | 1068843 | 01 | WV | W. VIRGINIA WORKERS COMP | OTHER |