Individual
CHARLES-CHIDI W OBASIOLU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
CTR FOR FERTILITY & REPRO HLTH, 133 BROOKLINE AVE, BOSTON, MA 02215
(617) 421-2987
(617) 421-2989
Mailing address
147 MILK ST FL 9, PROVIDER ENROLLMENT, BOSTON, MA 02109-4806
(617) 421-6540
Taxonomy
Speciality
Code
Description
License number
State
207VE0102X
Reproductive Endocrinology Physician
Primary
73931
MA
207VG0400X
Gynecology Physician
73931
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3180468
—
MA
Enumeration date
08/20/2006
Last updated
07/07/2011
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