Provider Demographics
NPI:1821092776
Name:GIORGETTI, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GIORGETTI
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 1:25 MARSTON ST FL 3
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2310
Mailing Address - Country:US
Mailing Address - Phone:978-688-3100
Mailing Address - Fax:978-688-3133
Practice Address - Street 1:25 MARSTON ST FL 3
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2310
Practice Address - Country:US
Practice Address - Phone:978-688-3100
Practice Address - Fax:978-688-3133
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78653207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARE2991OtherBLUE CROSS BLUE SHIELD
060061826OtherRAILROAD MEDICARE
MA70898OtherHARVARD PILGRIM HEALTH CA
NHF75016OtherANTHEM BLUE CROSS
170900OtherHEALTHSOURCE
MA078653OtherTUFTS HEALTH PLAN
5332818OtherCIGNA HEALTHCARE
NH30202031OtherNH MEDICAID
0016299OtherNEIGHBORHOOD HEALTH PLAN
01-00622OtherEVERCARE
978565OtherNETWORK HEALTH
MA3121135Medicaid
NHF75016OtherANTHEM BLUE CROSS
MARE2991Medicare ID - Type Unspecified