Provider Demographics
NPI:1619943222
Name:HOWARD, CHARLES D (MD, MMM, CHCQM)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:D
Last Name:HOWARD
Suffix:
Gender:M
Credentials:MD, MMM, CHCQM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 880
Mailing Address - Street 2:
Mailing Address - City:AYER
Mailing Address - State:MA
Mailing Address - Zip Code:01432-0880
Mailing Address - Country:US
Mailing Address - Phone:978-796-1418
Mailing Address - Fax:
Practice Address - Street 1:42 PATTON ROAD
Practice Address - Street 2:FEDERAL MEDICAL CENTER DEVENS
Practice Address - City:AYER
Practice Address - State:MA
Practice Address - Zip Code:01432
Practice Address - Country:US
Practice Address - Phone:978-796-1418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6544207W00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH82180337Medicaid
NH12091471OtherMULTIPLAN
NHH001145OtherCHAMPUS
NHA97567Medicare UPIN
NH82180337Medicaid