Individual
CHARISSA JOY PETTYJOHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
750 WASHINGTON ST., BOSTON, MA 02111
(617) 636-0265
Mailing address
19 PEVERELL ST, APT 3, DORCHESTER, MA 02125
(857) 212-3169
Taxonomy
Speciality
Code
Description
License number
State
207VH0002X
Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician
Primary
225481
MA
Other
Enumeration date
05/02/2007
Last updated
07/08/2007
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