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NPI Code Detail

MEDICARE: CHARLES J GAUDET M.D.

MEDICARE: CHARLES J GAUDET M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208200000XPlastic Surgery Physician7647NH
2208200000XPlastic Surgery Physician012347ME

General Provider Information

NPI Number : 1417955691
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES J GAUDET M.D.
Provider Business Mailing Address
First Line : 330 BORTHWICK AVE
Second Line : STE 206
City : PORTSMOUTH
State : NH
Zip : 03801-4174
Country : US
Telephone Number : 603-431-5488
Fax Number : 603-431-4680
Provider Business Practice Location Address
First Line : 330 BORTHWICK AVE
Second Line : STE 206
City : PORTSMOUTH
State : NH
Zip : 03801-4174
Country : US
Telephone Number : 603-431-5488
Fax Number : 603-431-4680
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2005
Last Update Date : 07/08/2007

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