Provider Demographics
NPI:1225181654
Name:CLADOUHOS, CHARIS E (MD)
Entity Type:Individual
Prefix:
First Name:CHARIS
Middle Name:E
Last Name:CLADOUHOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 WABAN AVE
Mailing Address - Street 2:
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02468-2101
Mailing Address - Country:US
Mailing Address - Phone:617-243-0440
Mailing Address - Fax:
Practice Address - Street 1:145 WABAN AVE
Practice Address - Street 2:
Practice Address - City:WABAN
Practice Address - State:MA
Practice Address - Zip Code:02468-2101
Practice Address - Country:US
Practice Address - Phone:617-243-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA776042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry