Individual
MR. CHARLES VINCENT PERNICIARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10406 SEASIDE WAY, TAMPA, FL 33615-4251
(904) 860-1929
Mailing address
10406 SEASIDE WAY, TAMPA, FL 33615-4251
(904) 860-1929
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
017322
LA
207N00000X
Dermatology Physician
21961
AZ
207N00000X
Dermatology Physician
28877
MN
207N00000X
Dermatology Physician
K6231
TX
207ND0900X
Dermatopathology Physician
042694
GA
207ND0900X
Dermatopathology Physician
2013-02379
NC
207ND0900X
Dermatopathology Physician
36240
SC
207ND0900X
Dermatopathology Physician
51624
FL
207ND0900X
Dermatopathology Physician
Primary
ME51624
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000837075B
—
GA
01
—
070014059
MEDICARE RR
FL
01
—
070014191
MEDICARE RR
GA
01
—
07BBSHB
MEDICARE
GA
01
—
10287
BCBS FL
FL
01
—
52332476003
BCBSGA
GA
01
—
HY024A
FL MEDAIACRE PTAN
FL
Enumeration date
05/22/2006
Last updated
03/23/2023
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