Healthcare Provider Details

I. General information

NPI: 1821069097
Provider Name (Legal Business Name): ANNE CHAFFEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SUMMER ST SUITE 690
WORCESTER MA
01608-1200
US

IV. Provider business mailing address

11 RIVINGTON DR
WEST BOYLSTON MA
01583-1529
US

V. Phone/Fax

Practice location:
  • Phone: 508-363-9530
  • Fax: 508-363-9535
Mailing address:
  • Phone: 508-363-9530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57262
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: