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General NPI Number Information
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NPI Number | 1396492104
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Entity Type | Organization
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Legal Business Name | MINIMALLY INVASIVE PODIATRY LLC
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Dates
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Enumeration Date | 03/02/2022
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | 322 PEARL STREET STE 1
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City | CAMBRIDGE
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State | MA
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Zip | 02139-4762
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Country | US
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Telephone | 267-230-3629
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Fax |
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Provider Business Mailing Address
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Address Line | 322 PEARL STREET SUITE 1
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City | CAMBRIDGE
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State | MA
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Zip | 02139-4762
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Country | US
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Telephone | 267-230-3629
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. QUINN TAYLOR CHARBONNEAU
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Credential | DPM
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Telephone | 267-230-3629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number |
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License Number State |
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