Provider Demographics
NPI:1629024344
Name:NOUVELLON, CHANTAL FRANCOISE (DO)
Entity Type:Individual
Prefix:DR
First Name:CHANTAL
Middle Name:FRANCOISE
Last Name:NOUVELLON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WINTER ST
Mailing Address - Street 2:STE 401
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-0961
Mailing Address - Country:US
Mailing Address - Phone:781-363-0390
Mailing Address - Fax:
Practice Address - Street 1:275 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-7246
Practice Address - Country:US
Practice Address - Phone:781-363-0390
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1545832084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ18550OtherBC/BS
MA457628OtherTUFTS HEALTH INSURANCE
MAJ18550OtherBC/BS
MA457628OtherTUFTS HEALTH INSURANCE