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Individual

CHARLENE P DEARDEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
88 E NEWTON ST, BOSTON, MA 02118-2308
(617) 638-8650
Mailing address
720 HARRISON AVE, DOB 503, BOSTON, MA 02118-2371

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2277
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
110109750A
MA
Enumeration date
05/12/2009
Last updated
09/28/2017
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