Provider Demographics
NPI:1861527798
Name:CHARRON, STACEY (MD)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:CHARRON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:LYN CHARRON
Other - Last Name:GILLESPIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:55 COLBY ST
Mailing Address - Street 2:
Mailing Address - City:COLEBROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03576-3047
Mailing Address - Country:US
Mailing Address - Phone:603-237-4955
Mailing Address - Fax:603-237-4882
Practice Address - Street 1:3 12TH ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570-3860
Practice Address - Country:US
Practice Address - Phone:603-752-7404
Practice Address - Fax:603-752-5194
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH123332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry