Provider Demographics
NPI:1609166339
Name:MASTER, MICHELLE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:MASTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:BELLOMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:332 WASHINGTON STREET
Mailing Address - Street 2:SUITE 200, FRASER BUILDING
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-6217
Mailing Address - Country:US
Mailing Address - Phone:781-235-4088
Mailing Address - Fax:781-235-1313
Practice Address - Street 1:332 WASHINGTON STREET
Practice Address - Street 2:SUITE 200, FRASER BUILDING
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-6217
Practice Address - Country:US
Practice Address - Phone:781-235-4088
Practice Address - Fax:781-235-1313
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA260287207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine