Provider Demographics
NPI:1508856691
Name:PU, CHARLES T (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:T
Last Name:PU
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-2066
Mailing Address - Fax:617-228-6306
Practice Address - Street 1:100 CHARLES RIVER PLAZA
Practice Address - Street 2:SUITE 501 CPZ 502
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2723
Practice Address - Country:US
Practice Address - Phone:617-726-2066
Practice Address - Fax:617-228-6306
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2012-07-19
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Provider Licenses
StateLicense IDTaxonomies
MA73771207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA073771OtherTUFTS HEALTH PLAN
MA3099466Medicaid
MAJ11653OtherBCBS MA
MAJ11653OtherBCBS MA
MAJ11653Medicare ID - Type Unspecified