Provider Demographics
NPI:1043377625
Name:TROY, CHARLES MCGREGOR II (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MCGREGOR
Last Name:TROY
Suffix:II
Gender:M
Credentials:PHD
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Mailing Address - Street 1:75 HERRICK STREET
Mailing Address - Street 2:PARKHURST MEDICAL BLDG SUITE 109
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5900
Mailing Address - Country:US
Mailing Address - Phone:978-777-1546
Mailing Address - Fax:978-777-1546
Practice Address - Street 1:75 HERRICK STREET
Practice Address - Street 2:PARKHURST MEDICAL BLDG SUITE 109
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-5900
Practice Address - Country:US
Practice Address - Phone:978-777-1546
Practice Address - Fax:978-777-1546
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA100579A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP01451OtherBLUE CROSS BLUE SHIELD
MA06350220OtherMAGELLAN HEALTH PLAN
MA718135OtherTUFRS HEALTH PLAN
MAP01451OtherBLUE CROSS BLUE SHIELD