Provider Demographics
NPI:1578699955
Name:VAZQUEZ, MICHAEL ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALEXANDER
Last Name:VAZQUEZ
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:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-0189
Mailing Address - Country:US
Mailing Address - Phone:508-478-7135
Mailing Address - Fax:508-473-7198
Practice Address - Street 1:321 FORTUNE BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1750
Practice Address - Country:US
Practice Address - Phone:508-478-7135
Practice Address - Fax:508-473-7198
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA236808207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9546288OtherAETNA
MAJ43824OtherBLUE CROSS BLUE SHIELD
MA2161982Medicaid
MAAA126766OtherHARVARD PILGRIM
497865OtherTUFTS
MAAA126766OtherHARVARD PILGRIM