Provider Demographics
NPI:1710420146
Name:CHARLES, JUNIOR
Entity Type:Individual
Prefix:
First Name:JUNIOR
Middle Name:
Last Name:CHARLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 UNION ST STE 304
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1348
Mailing Address - Country:US
Mailing Address - Phone:978-203-9191
Mailing Address - Fax:978-203-9195
Practice Address - Street 1:270 UNION ST
Practice Address - Street 2:STE 304
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-4210
Practice Address - Country:US
Practice Address - Phone:978-203-9191
Practice Address - Fax:978-203-9195
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-03
Last Update Date:2023-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA81-2998694Medicaid