Provider Demographics
NPI:1932243110
Name:GALATIS, MICHAEL JERRY (RN)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JERRY
Last Name:GALATIS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MALL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4100
Mailing Address - Country:US
Mailing Address - Phone:617-416-9591
Mailing Address - Fax:
Practice Address - Street 1:25 MALL RD
Practice Address - Street 2:SUITE 300
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4100
Practice Address - Country:US
Practice Address - Phone:617-416-9591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA129220163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0329584Medicaid