Provider Demographics
NPI:1104083138
Name:CHARLOTTE J RICHARDS MD PC
Entity type:Organization
Organization Name:CHARLOTTE J RICHARDS MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-696-4966
Mailing Address - Street 1:100 HIGHLAND ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3881
Mailing Address - Country:US
Mailing Address - Phone:617-686-4966
Mailing Address - Fax:617-696-7012
Practice Address - Street 1:100 HIGHLAND ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3881
Practice Address - Country:US
Practice Address - Phone:617-686-4966
Practice Address - Fax:617-696-7012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59904174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3038068Medicaid
MAA63287Medicare UPIN
MA3038068Medicaid