Provider Demographics
NPI:1780895433
Name:MCQUAID, CARLEEN ANNE (MS RNC NURSE PRACTIT)
Entity type:Individual
Prefix:MS
First Name:CARLEEN
Middle Name:ANNE
Last Name:MCQUAID
Suffix:
Gender:F
Credentials:MS RNC NURSE PRACTIT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:18 SYLVANIA GROVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01535
Mailing Address - Country:US
Mailing Address - Phone:508-248-4801
Mailing Address - Fax:508-248-6541
Practice Address - Street 1:246 SOUTHBRIDGE RD
Practice Address - Street 2:CHARLTON FAMILY PRACTICE
Practice Address - City:CHARLTON
Practice Address - State:MA
Practice Address - Zip Code:01507
Practice Address - Country:US
Practice Address - Phone:508-248-4801
Practice Address - Fax:508-248-6541
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA205387207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMCNP1401Medicare ID - Type Unspecified
S64712Medicare UPIN