Constance M Charles-Logan, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME61745 Issued in FL

Practice address

1414 59TH St W
Bradenton, FL 34209-4607

Phone

(941) 761-0663

Fax

(941) 761-3347

NPI assigned

Jun 19, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• West Coast Pediatrics

  • Pediatrics Physician
  • Bradenton, FL
  • NPI 1710235569

  Single Specialty

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715126400000",
    "number": "1225073422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 59TH ST W",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342094607",
            "telephone_number": "941-761-0663",
            "fax_number": "941-761-3347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 59TH ST W",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342094607",
            "telephone_number": "941-761-0663",
            "fax_number": "941-761-3347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHARLES-LOGAN",
        "first_name": "CONSTANCE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-19",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME61745",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME61745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandria Lynn Charest, D.C.
• Guek Charest, AP
• Steve Charest, AP
• Charles F. Hudson
• Charles T Polis Jr MD PA
• Sophie Charlson
• Balaj Chaudhry, DPM
• Pooja Chaudhry
• Sandra Checca, MD
• Henry Chen

• Pediatrics Physician in Bradenton, FL
• Providers in Bradenton, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.