Provider Demographics
NPI:1063703452
Name:CHAMSARIAN, ERROL M
Entity type:Individual
Prefix:MR
First Name:ERROL
Middle Name:M
Last Name:CHAMSARIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 713
Mailing Address - Street 2:
Mailing Address - City:ORLEANS
Mailing Address - State:MA
Mailing Address - Zip Code:02653-0713
Mailing Address - Country:US
Mailing Address - Phone:508-255-5931
Mailing Address - Fax:508-240-1597
Practice Address - Street 1:130 RT 6A
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653-3257
Practice Address - Country:US
Practice Address - Phone:508-255-5931
Practice Address - Fax:508-240-1597
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15099183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0497304Medicaid