Provider Demographics
NPI:1023037611
Name:GURVITZ, MICHELLE Z (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:Z
Last Name:GURVITZ
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 1:300 LONGWOOD AVE
Mailing Address - Street 2:BOSTON CHILDREN'S HOSPITAL / CARDIOLOGY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-6508
Mailing Address - Fax:617-739-8632
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:BOSTON CHILDREN'S HOSPITAL / CARDIOLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6508
Practice Address - Fax:617-739-8632
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61361207RC0000X
WAMD00045538208000000X, 2080P0202X
MA2457582080P0202X, 207RA0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0002XAllopathic & Osteopathic PhysiciansInternal MedicineAdult Congenital Heart Disease
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8436511Medicaid
CA00A613610OtherMEDICAL PPIN #
CAH85414Medicare UPIN
WA8436511Medicaid
CAWA61361BMedicare ID - Type UnspecifiedPPIN #