Healthcare Provider Details

I. General information

NPI: 1144541327
Provider Name (Legal Business Name): QUINN T CHARBONNEAU DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CHAMBERLAIN AVE APT 2
WINTHROP MA
02152-1582
US

IV. Provider business mailing address

2 CHAMBERLAIN AVE APT 2
WINTHROP MA
02152-1582
US

V. Phone/Fax

Practice location:
  • Phone: 617-846-2609
  • Fax: 617-846-3513
Mailing address:
  • Phone: 617-846-2609
  • Fax: 617-846-3513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2396
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: