Individual
DR. RICHARD N CHANNICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
55 FRUIT ST, COX 2, BOSTON, MA 02114-2621
(617) 724-3705
(617) 724-6954
Mailing address
PO BOX 9142, CHARLESTOWN, MA 02129-9142
(617) 724-3705
(617) 724-6954
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
56347
MA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
56347
MA
207RP1001X
Pulmonary Disease Physician
56347
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G626950
—
CA
05
—
110004417/A
—
MA
Enumeration date
07/11/2006
Last updated
02/28/2013
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