=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568335479
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLES BLANCHARD JR. LPN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2025
-----------------------------------------------------
Last Update Date | 09/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 SPRINGS RD
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01730-1114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-687-2000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 141 THAYER RD
-----------------------------------------------------
City | NEW IPSWICH
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03071-3324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-687-2000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | LN58407
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------