MEDICARE: CHARLES S WASSERMAN MD

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	75442	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659361020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES S WASSERMAN MD

Provider Business Mailing Address
First Line	:	133 OLD ROAD TO 9 ACRE COR
Second Line	:	EMERSON HOSPITAL
City	:	CONCORD
State	:	MA
Zip	:	01742-4159
Country	:	US
Telephone Number	:	978-287-3543
Fax Number	:	978-287-3695

Provider Business Practice Location Address
First Line	:	133 OLD ROAD TO 9 ACRE COR
Second Line	:	EMERSON HOSPITAL
City	:	CONCORD
State	:	MA
Zip	:	01742-4159
Country	:	US
Telephone Number	:	978-287-3543
Fax Number	:	978-287-3695

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	07/16/2007

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