Provider Demographics
NPI:1659384303
Name:JOSEPH M DE MICHELE MD FACS INC
Entity Type:Organization
Organization Name:JOSEPH M DE MICHELE MD FACS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:DE MICHELE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-595-0998
Mailing Address - Street 1:190 OCEAN STREET
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902
Mailing Address - Country:US
Mailing Address - Phone:781-595-0998
Mailing Address - Fax:
Practice Address - Street 1:190 OCEAN STREET
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902
Practice Address - Country:US
Practice Address - Phone:781-595-0998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25542207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
706020OtherTUFTS
17765OtherHARVARD PILGRIM
17765OtherHARVARD PILGRIM
B73728Medicare UPIN
MA=========0004Medicaid