Provider Demographics
NPI:1700852407
Name:O'GORMAN, MICHAEL CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHRISTOPHER
Last Name:O'GORMAN
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 1:10 TUCKERS WAY
Mailing Address - Street 2:
Mailing Address - City:HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645-1976
Mailing Address - Country:US
Mailing Address - Phone:413-768-8531
Mailing Address - Fax:
Practice Address - Street 1:90 LIBBEY PKWY SUITE 100
Practice Address - Street 2:SOUTH SHORE HOSPITAL CENTER FOR WOUND HEALING
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189
Practice Address - Country:US
Practice Address - Phone:781-624-4950
Practice Address - Fax:877-892-9770
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72633208600000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9708995Medicaid
MA3065308Medicaid
MA9708995Medicaid
MA3065308Medicaid
MAE65638Medicare UPIN