MEDICARE: CHARLES E. ADLER M.D.

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	2084P0800X	Psychiatry Physician	45052	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	045052	OTHER	MA	TUFTS HEALTH PLAN
2	B07193	OTHER	MA	BLUE CROSS OF MA

General Provider Information

NPI Number	:	1598777856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES E. ADLER M.D.

Provider Business Mailing Address
First Line	:	372 WASHINGTON ST
Second Line	:
City	:	WELLESLEY
State	:	MA
Zip	:	02481-6202
Country	:	US
Telephone Number	:	781-239-3550
Fax Number	:	781-239-3272

Provider Business Practice Location Address
First Line	:	372 WASHINGTON ST
Second Line	:
City	:	WELLESLEY
State	:	MA
Zip	:	02481-6202
Country	:	US
Telephone Number	:	781-239-3550
Fax Number	:	781-239-3272

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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