MEDICARE: CHARLES C HAROOTUNIAN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	226393	MA

General Provider Information

NPI Number	:	1396792081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES C HAROOTUNIAN D.O.

Provider Business Mailing Address
First Line	:	110 LONG POND RD
Second Line	:	SUITE 212
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-2642
Country	:	US
Telephone Number	:	508-866-7722
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 CARVER SQ
Second Line	:
City	:	CARVER
State	:	MA
Zip	:	02330-2014
Country	:	US
Telephone Number	:	508-866-7722
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	09/28/2012

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