Healthcare Provider Details

I. General information

NPI: 1114629706
Provider Name (Legal Business Name): CHARELLE MICHELLE ALLEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 BAY ST STE 204
TAUNTON MA
02780-1085
US

IV. Provider business mailing address

15 LA SALLE SQ
PROVIDENCE RI
02903-1814
US

V. Phone/Fax

Practice location:
  • Phone: 508-985-4105
  • Fax: 508-967-9308
Mailing address:
  • Phone: 401-444-6779
  • Fax: 401-444-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1028254
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: