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NPI Code Detail

MEDICARE: DR. CHARLES THOMAS KENDRICK M.D., D.M.D.

MEDICARE: DR. CHARLES THOMAS KENDRICK M.D., D.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
1207L00000XAnesthesiology Physician82014MA

General Provider Information

NPI Number : 1811977747
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES THOMAS KENDRICK M.D., D.M.D.
Provider Business Mailing Address
First Line : 80 HANNAH NILES WAY
Second Line :
City : BRAINTREE
State : MA
Zip : 02184-7260
Country : US
Telephone Number : 781-356-2120
Fax Number : 781-356-2120
Provider Business Practice Location Address
First Line : 30 WARREN ST
Second Line :
City : BRIGHTON
State : MA
Zip : 02135-3602
Country : US
Telephone Number : 617-254-3800
Fax Number : 617-779-1509
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2006
Last Update Date : 09/05/2007

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