Provider Demographics
NPI:1144201534
Name:ANDERSON, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WILLARD ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-1281
Mailing Address - Country:US
Mailing Address - Phone:617-479-1452
Mailing Address - Fax:617-479-3500
Practice Address - Street 1:51 PERFORMANCE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-3141
Practice Address - Country:US
Practice Address - Phone:781-340-0735
Practice Address - Fax:781-331-6355
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53192207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4144821OtherCIGNA
MA3063178Medicaid
MA4144821OtherHARVARD PILGRIM
MA501499OtherAETNA US HEALTH
MA715870OtherTUFTS HEALTH CARE
MAJ09389OtherBLUE CROSS BLUE SHIELD
MAJ09389OtherBLUE CROSS BLUE SHIELD
MA3063178Medicaid