Basic Information
| Provider Information | |||||||||
| NPI: | 1861527798 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHARRON | ||||||||
| FirstName: | STACEY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GILLESPIE | ||||||||
| OtherFirstName: | STACEY | ||||||||
| OtherMiddleName: | LYN CHARRON | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 55 COLBY ST | ||||||||
| Address2: | |||||||||
| City: | COLEBROOK | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035763047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032374955 | ||||||||
| FaxNumber: | 6032374882 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 12TH ST | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035703860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037527404 | ||||||||
| FaxNumber: | 6037525194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 12333 | NH | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.