Healthcare Provider Details

I. General information

NPI: 1174893523
Provider Name (Legal Business Name): SIMON DUCHARME M.D. M.SC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 PINE AVENUE WEST
MONTREAL QUEBEC
H3A 1A1
CA

IV. Provider business mailing address

2700 RUFUS-ROCKHEAD APT.802
MONTREAL QUEBEC
H3J 2Z7
CA

V. Phone/Fax

Practice location:
  • Phone: 514-398-7293
  • Fax: 514-398-4370
Mailing address:
  • Phone: 514-516-6396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1-11266-3
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: