Provider Demographics
NPI:1144541327
Name:CHARBONNEAU, QUINN T (DPM)
Entity type:Individual
Prefix:DR
First Name:QUINN
Middle Name:T
Last Name:CHARBONNEAU
Suffix:
Gender:F
Credentials:DPM
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2 CHAMBERLAIN AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-1582
Mailing Address - Country:US
Mailing Address - Phone:617-846-2609
Mailing Address - Fax:617-846-3513
Practice Address - Street 1:2 CHAMBERLAIN AVE APT 2
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-1582
Practice Address - Country:US
Practice Address - Phone:617-846-2609
Practice Address - Fax:617-846-3513
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2396213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist