Provider Demographics
NPI:1346354222
Name:HENRY, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HENRY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:77 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3601
Mailing Address - Country:US
Mailing Address - Phone:617-562-5485
Mailing Address - Fax:617-562-5415
Practice Address - Street 1:736 CAMBRIDGE ST # QN-3P
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:617-789-2623
Practice Address - Fax:617-562-5415
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2012-02-15
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Provider Licenses
StateLicense IDTaxonomies
MA734842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAE79824Medicare UPIN