Basic Information
| Provider Information | |||||||||
| NPI: | 1295721199 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROLLINGER | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 77 WARREN ST | ||||||||
| Address2: | RM 339 | ||||||||
| City: | BRIGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175625359 | ||||||||
| FaxNumber: | 6175625415 | ||||||||
| Practice Location | |||||||||
| Address1: | 1609 EGLIN ST | ||||||||
| Address2: | HANSCOM AFB | ||||||||
| City: | BEDFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017312613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813774740 | ||||||||
| FaxNumber: | 7812748538 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2005 | ||||||||
| LastUpdateDate: | 02/17/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 31131 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 2083X0100X | 31131 | MA | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
No ID Information.