Healthcare Provider Details

I. General information

NPI: 1972501740
Provider Name (Legal Business Name): CHARLTON ANESTHESIA GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 HIGHLAND AVE
FALL RIVER MA
02720-3703
US

IV. Provider business mailing address

340 MAIN ST STE. 670
WORCESTER MA
01608-1604
US

V. Phone/Fax

Practice location:
  • Phone: 508-679-3131
  • Fax: 508-679-7146
Mailing address:
  • Phone: 508-764-3566
  • Fax: 508-798-8012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateMA

VIII. Authorized Official

Name: WILLIAM J PENHALLURICK
Title or Position: PRESIDENT
Credential: MD
Phone: 508-279-3131