Provider Demographics
NPI:1598783292
Name:VASCONCELLES, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:VASCONCELLES
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 1:44 BINNEY ST
Mailing Address - Street 2:DANA-1234
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6013
Mailing Address - Country:US
Mailing Address - Phone:617-632-6049
Mailing Address - Fax:
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:DANA-1234
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6013
Practice Address - Country:US
Practice Address - Phone:617-632-6049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75143207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology