Provider Demographics
NPI:1508969387
Name:HIGGINSON, MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HIGGINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 BOSTON POST RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-1516
Mailing Address - Country:US
Mailing Address - Phone:860-388-9799
Mailing Address - Fax:860-388-6646
Practice Address - Street 1:455 BOSTON POST RD
Practice Address - Street 2:SUITE 10
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-1516
Practice Address - Country:US
Practice Address - Phone:860-388-9799
Practice Address - Fax:860-388-6646
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
010040453CT01Medicare ID - Type Unspecified
H17781Medicare UPIN