Provider Demographics
NPI:1396915708
Name:DR MICHAEL K GAVIGAN
Entity type:Organization
Organization Name:DR MICHAEL K GAVIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-563-7133
Mailing Address - Street 1:PO BOX 3227
Mailing Address - Street 2:STE 17
Mailing Address - City:POCASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02559-3227
Mailing Address - Country:US
Mailing Address - Phone:508-563-7133
Mailing Address - Fax:
Practice Address - Street 1:4 BARLOWS LANDING RD STE 17
Practice Address - Street 2:
Practice Address - City:POCASSET
Practice Address - State:MA
Practice Address - Zip Code:02559-1984
Practice Address - Country:US
Practice Address - Phone:508-563-7133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0361704Medicaid
4416070001Medicare NSC