Basic Information
| Provider Information | |||||||||
| NPI: | 1588701700 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCLUSKEY | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6500 66TH STREET NORTH | ||||||||
| Address2: | |||||||||
| City: | PINELLAS PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337043537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273471286 | ||||||||
| FaxNumber: | 7273848224 | ||||||||
| Practice Location | |||||||||
| Address1: | 6500 66TH ST | ||||||||
| Address2: | |||||||||
| City: | PINELLAS PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337815030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273471286 | ||||||||
| FaxNumber: | 7273453084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 02/27/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA1840 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | Y0EV6 | 01 | FL | BCBS OF FLORIDA | OTHER |