Provider Demographics
NPI:1457342198
Name:ZACK, MICHAEL BARUCH (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BARUCH
Last Name:ZACK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:101 MAIN ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4540
Mailing Address - Country:US
Mailing Address - Phone:781-391-6318
Mailing Address - Fax:781-391-2709
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4540
Practice Address - Country:US
Practice Address - Phone:781-391-6318
Practice Address - Fax:781-391-2709
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2013-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA33803207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA293909063OtherRAILROAD MEDICARE
MA21767OtherAETNA
MA4804295OtherUNITED HEALTH
MA0004629OtherNEIGHBORHOOD HEALTH
MA993560OtherNETWORK HEALTH
MAB10153001OtherCIGNA
MA23012OtherHARVARD PILGRIM
MA2050765Medicaid
MA40321OtherFALLON
MA708639OtherTUFTS
MA4804295OtherUNITED HEALTH