Basic Information
| Provider Information | |||||||||
| NPI: | 1639708068 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PLANCHE | ||||||||
| FirstName: | EUGENIE | ||||||||
| MiddleName: | VICTOIRE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15A MOCCASIN PATH | ||||||||
| Address2: | |||||||||
| City: | NATICK | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017606098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083148964 | ||||||||
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| Practice Location | |||||||||
| Address1: | 109 OAK ST # G30 | ||||||||
| Address2: | |||||||||
| City: | NEWTON UPPER FALLS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024641492 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176585611 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2020 | ||||||||
| LastUpdateDate: | 04/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
No ID Information.