Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | RN2264496 | MA |
NPI | 1205330578 |
---|---|
Provider Name | Charles Mats Berry |
First Address | Chelsea, MA 02150-2129 |
Second Address | Salem, MA 01970-2141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2018 |
Last Update Date | 21/03/2018 |