Provider Demographics
NPI:1780674531
Name:BARZA, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:BARZA
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 1:45 TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3964
Mailing Address - Country:US
Mailing Address - Phone:617-964-4749
Mailing Address - Fax:
Practice Address - Street 1:2100 DORCHESTER AVENUE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5666
Practice Address - Country:US
Practice Address - Phone:617-296-4000
Practice Address - Fax:617-474-3855
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA35917207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2047543Medicaid
MA2047543Medicaid
MAD83017Medicare UPIN