Provider Demographics
NPI:1609828920
Name:MECLEY, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:MECLEY
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 1:140 YARMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3040
Mailing Address - Country:US
Mailing Address - Phone:508-778-8818
Mailing Address - Fax:
Practice Address - Street 1:140 YARMOUTH RD
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3040
Practice Address - Country:US
Practice Address - Phone:508-778-8818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA57050207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA057050OtherTUFTS
MA3039773Medicaid
MA3738OtherHPHC
MAJ07901OtherBLUE SHIELD
MA1241235OtherAETNA
MA0212863OtherCIGNA
MAJ07901Medicare ID - Type UnspecifiedMEDICARE
MAD87821Medicare UPIN