MEDICARE: JOSHUA ROBERT OUELLETTE

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	213E00000X	Podiatrist	2532	MA

General Provider Information

NPI Number	:	1760944136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA ROBERT OUELLETTE

Provider Business Mailing Address
First Line	:	1244 BOYLSTON ST FL 101
Second Line	:
City	:	CHESTNUT HILL
State	:	MA
Zip	:	02467-2115
Country	:	US
Telephone Number	:	617-232-1752
Fax Number	:	617-566-3919

Provider Business Practice Location Address
First Line	:	1244 BOYLSTON ST FL 101
Second Line	:
City	:	CHESTNUT HILL
State	:	MA
Zip	:	02467-2115
Country	:	US
Telephone Number	:	617-232-1752
Fax Number	:	617-566-3919

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

Provider Enumeration Date	:	04/03/2019
Last Update Date	:	01/15/2026

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