Provider Demographics
NPI:1891729505
Name:CARL, CHARLES WINGARD JR (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:WINGARD
Last Name:CARL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BOSTON POST RD
Mailing Address - Street 2:STE 205
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-2435
Mailing Address - Country:US
Mailing Address - Phone:508-358-2050
Mailing Address - Fax:508-358-4481
Practice Address - Street 1:16 BOSTON POST RD
Practice Address - Street 2:STE 205
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-2435
Practice Address - Country:US
Practice Address - Phone:508-358-2050
Practice Address - Fax:508-358-4481
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA310762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA33616OtherCIGNA
MA031076OtherTUFTS
4130663OtherAETNA
J05795OtherBCBS
MA3011739Medicaid
MA33616OtherCIGNA
J05795Medicare ID - Type Unspecified