Provider Demographics
NPI:1821070897
Name:MUDGETT, MICHELE K (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:K
Last Name:MUDGETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:143 LONGWATER DR
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1683
Mailing Address - Country:US
Mailing Address - Phone:781-878-5200
Mailing Address - Fax:781-871-2940
Practice Address - Street 1:143 LONGWATER DR
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1683
Practice Address - Country:US
Practice Address - Phone:781-878-5200
Practice Address - Fax:781-871-2940
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA51499207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0016424OtherNHP
MA042297845OtherTRICARE
MA042297845OtherUNITED HEALTH CARE
MA042297845OtherHCVM
MA766913OtherTUFTS
MA2090643Medicaid
MA4218611OtherAETNA
MA042297845OtherPRIVATE HEALTHCARE SYSTEM
MA766913OtherTUFTS MEDICARE PREFERRED
MA62253OtherHARVARD PILGRIM
MA042297845OtherGIC UNICARE
MA042297845OtherGREAT WEST HEALTH CARE
MAB10353601OtherCIGNA
MAJ02498OtherBCBS
MA766913OtherTUFTS MEDICARE PREFERRED
MA766913OtherTUFTS