Provider Demographics
NPI:1063516573
Name:PAO, CHARLES C (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:C
Last Name:PAO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:40 WALNUT STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2102
Mailing Address - Country:US
Mailing Address - Phone:781-943-3000
Mailing Address - Fax:781-943-3037
Practice Address - Street 1:40 WALNUT STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2102
Practice Address - Country:US
Practice Address - Phone:781-943-3000
Practice Address - Fax:781-943-3037
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2019-06-26
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Provider Licenses
StateLicense IDTaxonomies
MAMA150435207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110159991OtherRAILROAD MEDICARE
MD65669OtherHARVARD PILGRIM
MA3153461Medicaid
MAJ16706OtherBLUESHIELD OF MA
MA3505250002OtherCIGNA
MA150435OtherTUFTS
MA04-01792OtherUNITED HEALTHCARE
MACX8335Medicare PIN
MAG27251Medicare UPIN