Provider Demographics
NPI:1639770829
Name:MORRIS, MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MORRIS
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:MGH BACK BAY HEALTHCARE CENTER
Mailing Address - Street 2:388 COMMONWEALTH AVE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-2800
Mailing Address - Country:US
Mailing Address - Phone:617-267-7171
Mailing Address - Fax:
Practice Address - Street 1:MGH BACK BAY HEALTHCARE CENTER
Practice Address - Street 2:388 COMMONWEALTH AVE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-2800
Practice Address - Country:US
Practice Address - Phone:617-267-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1017353207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine