Provider Demographics
NPI:1861021784
Name:CHARLES-LAROSE, JESSICA ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANNE
Last Name:CHARLES-LAROSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WHITE OAK LN
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-7268
Mailing Address - Country:US
Mailing Address - Phone:781-267-4148
Mailing Address - Fax:
Practice Address - Street 1:25 LEAVY DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110
Practice Address - Country:US
Practice Address - Phone:603-472-7233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH33679171100000X, 207Q00000X
64272390200000X
MEEC221041390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171100000XOther Service ProvidersAcupuncturist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program