Provider Demographics
NPI:1477513679
Name:MICHAELSON, HOLLY K (MD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:K
Last Name:MICHAELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:76 CARLON DR
Mailing Address - Street 2:#A
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2373
Mailing Address - Country:US
Mailing Address - Phone:413-584-4637
Mailing Address - Fax:413-584-4787
Practice Address - Street 1:76 CARLON DR
Practice Address - Street 2:#A
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2373
Practice Address - Country:US
Practice Address - Phone:413-584-4637
Practice Address - Fax:413-584-4787
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA221242208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA04-3194547OtherNORTH AMERICAN PREFERRED
MA04-3194547OtherUNITED HEALTHCARE
MA04-3194547OtherGREAT-WEST
MA04-3194547OtherPLAN VISTA
MA35140OtherHNE
MAAA18165OtherHARVARD PILGRIM
MA04-3194547OtherNORTHEAST HEALTH DIRECT
MA04-3194547OtherPHCS
MA000000028880OtherBMC
MA04-3194547OtherUNICARE/GIC
MA221242OtherCONNECTICARE
MA3632800OtherAETNA
MAJ27862OtherBCBSMA
MA04-3194547OtherCONSOLIDATED
MA04-3194547OtherNORTHEAST HEALTHCARE ALLI
MA6850767OtherCIGNA
MA2075725Medicaid
MA469819OtherTUFTS
MA04-3194547OtherNORTHEAST HEALTHCARE ALLI
MA469819OtherTUFTS