Individual
CHARLES ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
26 CITY HALL MALL, MEDFORD, MA 02155-4754
(781) 306-5184
(781) 306-5080
Mailing address
147 MILK ST, BOSTON, MA 02109-4806
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3368
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0014539
NHP
MA
01
—
003368
TUFTS
MA
05
—
0312932
—
MA
01
—
8278875-002
CIGNA
MA
01
—
W16027
BCBS
MA
Enumeration date
12/27/2006
Last updated
06/08/2011
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