Healthcare Provider Details

I. General information

NPI: 1871721258
Provider Name (Legal Business Name): CHERI BLAUWET MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

89 ELM RD
NEWTON MA
02460-2100
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-9702
  • Fax:
Mailing address:
  • Phone: 650-283-0219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number260974
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: