Healthcare Provider Details

I. General information

NPI: 1962690461
Provider Name (Legal Business Name): CHARLES TREY M D & ASSOCIATES P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 FRANCIS ST SUITE 8A
BOSTON MA
02215-5501
US

IV. Provider business mailing address

110 FRANCIS ST SUITE 8A
BOSTON MA
02215-5501
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-9252
  • Fax: 617-632-9255
Mailing address:
  • Phone: 617-632-9252
  • Fax: 617-632-9255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number57207
License Number StateMA

VIII. Authorized Official

Name: DR. GARY TREY
Title or Position: PRESIDENT
Credential: M.D. M.P.H.
Phone: 617-632-9252