Provider Demographics
NPI:1972771376
Name:STUART, CHARLES L (LIC AC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:L
Last Name:STUART
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BALDWINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01436-1407
Mailing Address - Country:US
Mailing Address - Phone:978-939-8544
Mailing Address - Fax:
Practice Address - Street 1:10 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BALDWINVILLE
Practice Address - State:MA
Practice Address - Zip Code:01436-1407
Practice Address - Country:US
Practice Address - Phone:978-939-8544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA126171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist