Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 041519 | CT |
N | 204F00000X | Transplant Surgeon | MD12241 | RI |
N | 208200000X | Surgeon | 041519 | CT |
N | 208600000X | Surgeon | 041519 | CT |
Y | 208200000X | Surgeon | 277097 | MA |
Y | 208600000X | Surgeon | 277097 | MA |
N | 208200000X | Surgeon | MD12241 | RI |
N | 208600000X | Surgeon | MD12241 | RI |
NPI | 1720087919 |
---|---|
Provider Name | Kevin P Charpentier |
First Address | Brockton, MA 02302-3308 |
Second Address | Brockton, MA 02302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 28/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7059024 | (05) | RI |