Provider Demographics
NPI:1255446894
Name:AGNONE, CHARLOTTE MARIE (MD FACS)
Entity type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:MARIE
Last Name:AGNONE
Suffix:
Gender:F
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 WOLF RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-2995
Mailing Address - Country:US
Mailing Address - Phone:614-499-1863
Mailing Address - Fax:
Practice Address - Street 1:3303 WOLF RIDGE DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2995
Practice Address - Country:US
Practice Address - Phone:614-499-1863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.062148202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0862222Medicaid
F07895Medicare UPIN
OH0862222Medicaid