Provider Demographics
NPI:1720214349
Name:JAIN, CHARU K (MD)
Entity type:Individual
Prefix:MISS
First Name:CHARU
Middle Name:K
Last Name:JAIN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2620
Mailing Address - Country:US
Mailing Address - Phone:617-414-4505
Mailing Address - Fax:
Practice Address - Street 1:830 OAK ST STE 223E
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1191
Practice Address - Country:US
Practice Address - Phone:508-427-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA281404207V00000X
GA066985207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003118693AMedicaid