Healthcare Provider Details

I. General information

NPI: 1487755229
Provider Name (Legal Business Name): CHARLOTTE A MAO MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6832
  • Fax: 617-730-0911
Mailing address:
  • Phone: 617-355-6832
  • Fax: 617-730-0911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number77816
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: