Provider Demographics
NPI:1447201850
Name:BIGBY, MICHAEL ELLIOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ELLIOTT
Last Name:BIGBY
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 1:330 BROOKLINE AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:617-667-3753
Mailing Address - Fax:617-975-5033
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:CC2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-3753
Practice Address - Fax:617-975-5033
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47598207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0144363Medicaid
MA57075Medicare UPIN
MA0144363Medicare ID - Type Unspecified
MA0144363Medicaid