Healthcare Provider Details

I. General information

NPI: 1457341083
Provider Name (Legal Business Name): MICHAEL EDWARD CHARNESS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 VFW PKWY VA MEDICAL CENTER DEPT OF NEUROLOGY
WEST ROXBURY MA
02132-4927
US

IV. Provider business mailing address

1400 VFW PKWY VA MEDICAL CENTER DEPT OF NEUROLOGY
WEST ROXBURY MA
02132-4927
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-7432
  • Fax:
Mailing address:
  • Phone: 617-732-7432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number71358
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: