Healthcare Provider Details

I. General information

NPI: 1245822352
Provider Name (Legal Business Name): CAROLINE MARIE REGELOUS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 MOUNT AUBURN ST
CAMBRIDGE MA
02138-5597
US

IV. Provider business mailing address

30 TRINITY AVE
WORCESTER MA
01605-1924
US

V. Phone/Fax

Practice location:
  • Phone: 617-492-3500
  • Fax:
Mailing address:
  • Phone: 508-769-8155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN2321328
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: