Healthcare Provider Details

I. General information

NPI: 1225363674
Provider Name (Legal Business Name): GEORGIANA CHEVRY M.ED.,C.L.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2009
Last Update Date: 03/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 BERWICK RD
MEDFORD MA
02155-6017
US

IV. Provider business mailing address

7 BERWICK RD
MEDFORD MA
02155-6017
US

V. Phone/Fax

Practice location:
  • Phone: 857-236-4819
  • Fax:
Mailing address:
  • Phone: 857-236-4819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: