Provider Demographics
NPI:1629062781
Name:CHABOT, MICHELE T (MD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:T
Last Name:CHABOT
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 1:100 HIGHLAND ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3881
Mailing Address - Country:US
Mailing Address - Phone:617-696-1460
Mailing Address - Fax:617-296-5801
Practice Address - Street 1:100 HIGHLAND ST
Practice Address - Street 2:SUITE 105
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3881
Practice Address - Country:US
Practice Address - Phone:617-696-1460
Practice Address - Fax:617-296-5801
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78819207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
043243146OtherUNICARE
P00039909OtherRR MEDICARE
043243146OtherHC VM
21232424344OtherBEECH STREET
3157475OtherAETNA HEALTH PLAN
J16434OtherHMO BLUE
0403312OtherUNITED HEALTHCARE OF NE
043243146OtherMEDICARE PREFERRED TUFTS
078819OtherTUFTS
6261611009OtherCIGNA
M15986OtherBLUE CROSS INDEMNITY
J16434OtherBLUE CROSS INDEMNITY
043243146OtherGREAT WEST HEALTHCARE
J16434OtherBLUE CARE ELECT
MA3148823Medicaid
66029OtherHARVARD PILGRIM
J16434OtherBLUE CROSS INDEMNITY
043243146OtherGREAT WEST HEALTHCARE