Provider Demographics
NPI:1679503270
Name:BUSH, MICHELLE L (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:BUSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:95 CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3155
Mailing Address - Country:US
Mailing Address - Phone:781-762-5858
Mailing Address - Fax:781-949-4343
Practice Address - Street 1:128 CARNEGIE ROW
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-5161
Practice Address - Country:US
Practice Address - Phone:781-762-5858
Practice Address - Fax:781-949-4343
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2019-09-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA221250207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I36443Medicare UPIN