Provider Demographics
NPI:1255325221
Name:SUMMERS, MICHAEL CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHARLES
Last Name:SUMMERS
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 1:12 MARGARET ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02113-2530
Mailing Address - Country:US
Mailing Address - Phone:781-674-1242
Mailing Address - Fax:781-674-2442
Practice Address - Street 1:12 MARGARET ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02113-2530
Practice Address - Country:US
Practice Address - Phone:781-764-1242
Practice Address - Fax:781-674-2442
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77471174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist