Provider Demographics
NPI:1285612101
Name:GARABEDIAN, CHARLES A (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:GARABEDIAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT - 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8104
Mailing Address - Fax:617-421-3487
Practice Address - Street 1:86 BAKER AVE EXTENSION
Practice Address - Street 2:CONCORD HILLSIDE MEDICAL ASSOCIATES
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2188
Practice Address - Country:US
Practice Address - Phone:978-287-9400
Practice Address - Fax:978-287-9408
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2009-05-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA73999208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4318317OtherAETNA
MAJ12391OtherBLUE CROSS
MA3089991Medicaid
MA1202090OtherUNITED HEALTHCARE
MA20981OtherHARVARD PILGRIM
MA073999OtherTUFTS
MA0016156OtherNEIGHBOR HOOD HEALTH
MAJ12391Medicare ID - Type Unspecified
MA3089991Medicaid