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General NPI Number Information
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NPI Number | 1245612605
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Entity Type | Individual
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Provider Name | CARLA MARISA BASADRE QUIROZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/22/2015
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Last Update Date | 09/03/2019
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Provider Practice Location Address
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Address Line | 147 PELHAM ST
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City | METHUEN
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State | MA
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Zip | 01844-2060
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Country | US
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Telephone | 978-683-3491
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Fax | 978-683-3058
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Provider Business Mailing Address
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Address Line | 147 PELHAM ST
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City | METHUEN
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State | MA
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Zip | 01844-2060
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Country | US
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Telephone | 978-683-3491
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Fax | 978-683-3058
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 277313
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License Number State | MA
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