Provider Demographics
NPI:1902865017
Name:SAMMARITANO, MICHELE R (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:R
Last Name:SAMMARITANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 MAIN STREET
Mailing Address - Street 2:UNIT ONE
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176
Mailing Address - Country:US
Mailing Address - Phone:781-979-9009
Mailing Address - Fax:781-979-9008
Practice Address - Street 1:830 MAIN ST UNIT 1
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-2711
Practice Address - Country:US
Practice Address - Phone:781-979-9009
Practice Address - Fax:781-979-9008
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156034174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3178552Medicaid
MA3178552Medicaid
A23779Medicare ID - Type Unspecified