Provider Demographics
NPI:1356452825
Name:TOUSSAINT, JEAN-CHARLES M (MD)
Entity Type:Individual
Prefix:MR
First Name:JEAN-CHARLES
Middle Name:M
Last Name:TOUSSAINT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RYDER ROAD
Mailing Address - Street 2:PO BOX 641
Mailing Address - City:TRURO
Mailing Address - State:MA
Mailing Address - Zip Code:02666
Mailing Address - Country:US
Mailing Address - Phone:481-756-7243
Mailing Address - Fax:
Practice Address - Street 1:41 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890
Practice Address - Country:US
Practice Address - Phone:781-756-7243
Practice Address - Fax:781-756-2987
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA46474207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0177598Medicaid
B53116Medicare ID - Type Unspecified
MA0177598Medicaid