Provider Demographics
NPI:1568180214
Name:ABERCROMBIE, CHARLIA
Entity Type:Individual
Prefix:
First Name:CHARLIA
Middle Name:
Last Name:ABERCROMBIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 ARSENAL ST UNIT 2101
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2943
Mailing Address - Country:US
Mailing Address - Phone:857-417-5144
Mailing Address - Fax:
Practice Address - Street 1:850 ALBANY ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02119-2545
Practice Address - Country:US
Practice Address - Phone:617-638-8014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program