Provider Demographics
NPI:1063491702
Name:MICHAUD, MARC J (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:J
Last Name:MICHAUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:17 RIVERSIDE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-1304
Mailing Address - Country:US
Mailing Address - Phone:603-883-0091
Mailing Address - Fax:603-881-3739
Practice Address - Street 1:700 LAKE AVE
Practice Address - Street 2:SUITE ONE
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-2734
Practice Address - Country:US
Practice Address - Phone:603-669-5454
Practice Address - Fax:603-641-0360
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2023-11-21
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Provider Licenses
StateLicense IDTaxonomies
AZ31401207XX0004X
NH12269207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30204355Medicaid
NH0389700001Medicare NSC
NHNX3783Medicare PIN
NH30204355Medicaid