Provider Demographics
NPI:1245612605
Name:BASADRE QUIROZ, CARLA MARISA (MD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:MARISA
Last Name:BASADRE QUIROZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:147 PELHAM ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-2060
Mailing Address - Country:US
Mailing Address - Phone:978-683-3491
Mailing Address - Fax:978-683-3058
Practice Address - Street 1:147 PELHAM ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-2060
Practice Address - Country:US
Practice Address - Phone:978-683-3491
Practice Address - Fax:978-683-3058
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2019-09-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA277313207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine