Provider Demographics
NPI:1235717067
Name:AVERY, MICHAEL (MD, PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:AVERY
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 FRANCIS STREET, SUITE 9B
Mailing Address - Street 2:LOWRY MEDICAL OFFICE BUILDING
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-632-9236
Mailing Address - Fax:
Practice Address - Street 1:110 FRANCIS STREET, SUITE 9B
Practice Address - Street 2:LOWRY MEDICAL OFFICE BUILDING
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-632-9236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program