Healthcare Provider Details

I. General information

NPI: 1811940737
Provider Name (Legal Business Name): CHARLOTTE M BONEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 02/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 WASON AVE
SPRINGFIELD MA
01107-1274
US

IV. Provider business mailing address

280 CHESTNUT ST 2ND FLOOR
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-5437
  • Fax: 413-794-0395
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number151328
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: