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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 14 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.

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Identifiers

StateTypeNumberIssuer
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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