Provider Demographics
NPI:1881221927
Name:ROBERTS, CHARLESON (EMT-B)
Entity Type:Individual
Prefix:
First Name:CHARLESON
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 BUFFINTON ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-6767
Mailing Address - Country:US
Mailing Address - Phone:774-309-4893
Mailing Address - Fax:
Practice Address - Street 1:640 STATE RD
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1808
Practice Address - Country:US
Practice Address - Phone:508-999-9969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA893509146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic