Provider Demographics
NPI:1114985041
Name:BELANGER, MICHAEL JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:BELANGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1524 ATWOOD AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3228
Mailing Address - Country:US
Mailing Address - Phone:401-351-6200
Mailing Address - Fax:401-351-6201
Practice Address - Street 1:1524 ATWOOD AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3228
Practice Address - Country:US
Practice Address - Phone:401-351-6200
Practice Address - Fax:401-351-6201
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD09773207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI3849OtherNEIGHBORHOOD HEALTH PLANS
RI7006586Medicaid
MA009773OtherTUFTS HEALTH PLANS
050397249OtherUNITEDHEALTHCARE
050397249OtherWORKERS COMPENSATION
RI29556OtherBC BS OF RI
RI402575OtherBLUECHIP OF RI
7104180OtherAETNA
MAAA33827OtherHARVARD PILGRIM
050397249OtherFIRSTHEALTH/COVENTRY/HCVM
CD1829OtherRAILROAD MEDICARE
050397249OtherPEQUOT PLUS HEALTH PLANS
103714900OtherU.S. DEPT. OF LABOR-WC
7104180OtherAETNA
050397249OtherFIRSTHEALTH/COVENTRY/HCVM
050397249OtherPEQUOT PLUS HEALTH PLANS
RI7006586Medicaid