Provider Demographics
NPI:1295721199
Name:ROLLINGER, CHARLES L (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:L
Last Name:ROLLINGER
Suffix:
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 1:77 WARREN ST
Mailing Address - Street 2:RM 339
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135
Mailing Address - Country:US
Mailing Address - Phone:617-562-5359
Mailing Address - Fax:617-562-5415
Practice Address - Street 1:1609 EGLIN ST
Practice Address - Street 2:HANSCOM AFB
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01731-2613
Practice Address - Country:US
Practice Address - Phone:781-377-4740
Practice Address - Fax:781-274-8538
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA31131207Q00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A37805Medicare UPIN
MAJ04473Medicare ID - Type Unspecified