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General NPI Number Information
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NPI Number | 1104083138
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Entity Type | Organization
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Legal Business Name | CHARLOTTE J RICHARDS MD PC
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 100 HIGHLAND ST SUITE 103
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City | MILTON
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State | MA
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Zip | 02186-3881
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Country | US
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Telephone | 617-686-4966
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Fax | 617-696-7012
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Provider Business Mailing Address
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Address Line | 100 HIGHLAND ST SUITE 103
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City | MILTON
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State | MA
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Zip | 02186-3881
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Country | US
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Telephone | 617-686-4966
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Fax | 617-696-7012
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLOTTE J RICHARDS
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Credential | M.D.
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Telephone | 617-696-4966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 59904
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License Number State | MA
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