Provider Demographics
NPI:1306851738
Name:MICHAELSON, WENDY SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:SUE
Last Name:MICHAELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:251 CAUSEWAY ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2148
Mailing Address - Country:US
Mailing Address - Phone:617-248-1470
Mailing Address - Fax:617-248-1282
Practice Address - Street 1:251 CAUSEWAY ST
Practice Address - Street 2:VA BOSTON HEALTH CARE SYSTEM
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2148
Practice Address - Country:US
Practice Address - Phone:617-248-1470
Practice Address - Fax:617-248-1282
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA46023207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAVAD-000Medicare UPIN