Individual
DR. CHARLES M. BLISS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
830 HARRISON AVENUE, MOAKLEY, 2ND FLOOR, BOSTON, MA 02118-2905
(617) 638-6525
(617) 638-7448
Mailing address
801 ALBANY ST FL G, BOSTON, MA 02119-3791
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
74783
MA
207RG0100X
Gastroenterology Physician
Primary
74783
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110057505A
—
MA
Enumeration date
12/15/2005
Last updated
05/03/2021
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