Connolly, Charles William
Connolly, Charles William is an sole proprietor health care provider with primary practice located at 120 College Ave , Somerville MA 02144-1919. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Connolly, Charles William can be contacted via phone (617) 776-2500.Contact Information
Primary practice address
120 College Ave
Somerville MA 02144-1919
Phone: (617) 776-2500
Fax: (617) 776-3850
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Podiatric Medicine & Surgery Service Providers / Podiatrist | 213E00000X | 1784 | Massachusetts |
Profile Details
NPI number | 1932105095 |
---|---|
LBN Legal business name | Connolly, Charles William |
Credentials | Doctor of Podiatric Medicine (DPM) |
Entity | Individual |
Sole proprietor 1 | Yes |
Enumeration date | Jun 23rd, 2005 |
Last updated | Apr 24th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1932105095 | NPPES |
Massachusetts | Other | Y70860 | BLUE SHIELD OF MA |
Massachusetts | Other | 709158 | BLUE SHIELD OF MA |
Massachusetts | MEDICAID | 0361968 | BLUE SHIELD OF MA |
Massachusetts | Other | 33386 | BLUE SHIELD OF MA |
Massachusetts | Other | 2700037 | BLUE SHIELD OF MA |
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