Provider Demographics
NPI:1649277542
Name:SASMOR, MICHELE T (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:T
Last Name:SASMOR
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 1:21 HIGHLAND AVE
Mailing Address - Street 2:SUITE 3-4A
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3872
Mailing Address - Country:US
Mailing Address - Phone:978-462-8300
Mailing Address - Fax:978-462-8301
Practice Address - Street 1:21 HIGHLAND AVE
Practice Address - Street 2:SUITE 3-4A
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3872
Practice Address - Country:US
Practice Address - Phone:978-462-8300
Practice Address - Fax:978-462-8301
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80127208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ30842OtherBLUE SHIELD
MA3128938Medicaid
MAE54880Medicare UPIN
MAJ30842Medicare ID - Type Unspecified