Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MT209301 | PA |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 67334 | CT |
NPI | 1396130639 |
---|---|
Provider Name | Ryan S Charette |
First Address | Philadelphia, PA 19104-5545 |
Second Address | Wallingford, CT 06492 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2015 |
Last Update Date | 21/06/2021 |