Healthcare Provider Details

I. General information

NPI: 1972771376
Provider Name (Legal Business Name): CHARLES L STUART LIC. AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CHESTNUT ST
BALDWINVILLE MA
01436-1407
US

IV. Provider business mailing address

10 CHESTNUT ST
BALDWINVILLE MA
01436-1407
US

V. Phone/Fax

Practice location:
  • Phone: 978-939-8544
  • Fax:
Mailing address:
  • Phone: 978-939-8544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number126
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: