Provider Demographics
NPI:1649239849
Name:ROBERTS, CHARLES M (MD PHD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:M
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 BINNEY ST
Mailing Address - Street 2:M657, DANA FARBER CANCER INSTITUTE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-632-5297
Mailing Address - Fax:617-632-6845
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:M657, DANA FARBER CANCER INSTITUTE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-632-5297
Practice Address - Fax:617-632-6845
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1546102080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
206814OtherHPHC DFCI ONLY
000000025974OtherBMC HEALTHNET
771511OtherTUFTS
3205932OtherMASS HEALTH
2938399OtherAETNA US HEALTHCARE
60716OtherFALLON COMMUNITY HEALTH
1996161OtherCIGNA
MAJ22083OtherBLUE CROSS BLUE SHIELD
60716OtherFALLON COMMUNITY HEALTH
771511OtherTUFTS