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Contact Information

CHARLES W CONNOLLY, DPM
120 COLLEGE AVE
SOMERVILLE, MA02144-1919
 Phone: 617-776-2500
 Fax: 617-776-3850
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Podiatrist

213E00000X 48 Podiatry
Indicates primary specialty

NPI Profile & details for CHARLES W CONNOLLY · (Male)

NPI # 1932105095
Status Active
Credentials DPM (Doctor of Podiatric Medicine)
Entity Individual
Enumeration date 06/23/2005
Last updated 04/24/2012 - About 14 years ago
Sole proprietor 1 Yes
Identifiers
  • MA License # 1784
  • MA Medicaid 0361968
  • MA Other Y70860 BLUE SHIELD OF MA
  • MA Other 33386 HARVARD PILGRIM HEALTH CA
  • MA Other 709158 TUFTS HEALTH PLAN
  • MA Other 2700037 UNITED HEALTHCARE
Hospital affiliation(s)
  • NORTH SHORE MEDICAL CENTER - (Acute Care)
    81 HIGHLAND AVENUE
    SALEM, MA 01970
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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