Basic Information
| Provider Information | |||||||||
| NPI: | 1245612605 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BASADRE QUIROZ | ||||||||
| FirstName: | CARLA | ||||||||
| MiddleName: | MARISA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 147 PELHAM ST | ||||||||
| Address2: | |||||||||
| City: | METHUEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018442060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786833491 | ||||||||
| FaxNumber: | 9786833058 | ||||||||
| Practice Location | |||||||||
| Address1: | 147 PELHAM ST | ||||||||
| Address2: | |||||||||
| City: | METHUEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018442060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786833491 | ||||||||
| FaxNumber: | 9786833058 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2015 | ||||||||
| LastUpdateDate: | 09/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | 277313 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
No ID Information.