Provider Demographics
NPI:1760481501
Name:PAYNE, MICHAEL CLARENCE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CLARENCE
Last Name:PAYNE
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-2520
Mailing Address - Country:US
Mailing Address - Phone:413-441-3718
Mailing Address - Fax:413-458-8663
Practice Address - Street 1:230 HIGHLAND AVE
Practice Address - Street 2:SOMERVILLE HOSPITAL / THE CAMBRIDGE HEALTH ALLIANCE
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-1408
Practice Address - Country:US
Practice Address - Phone:617-665-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420007895207RG0100X
MA52588207RG0100X
TNMD38144207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6181678Medicaid
74456Medicare UPIN
MA6181678Medicaid