Provider Demographics
NPI:1447321385
Name:CHARLTON FAMILY PRACTICE
Entity type:Organization
Organization Name:CHARLTON FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-248-7849
Mailing Address - Street 1:246 SOUTHBRIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:CHARLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01507-5237
Mailing Address - Country:US
Mailing Address - Phone:508-248-7849
Mailing Address - Fax:508-248-6541
Practice Address - Street 1:246 SOUTHBRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:CHARLTON
Practice Address - State:MA
Practice Address - Zip Code:01507-5237
Practice Address - Country:US
Practice Address - Phone:508-248-7849
Practice Address - Fax:508-248-6541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA49523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9758283Medicaid
MA9758283Medicaid