Provider Demographics
NPI:1104813641
Name:COREA, MICHAEL E (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:COREA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:910 WASHINGTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-6022
Mailing Address - Country:US
Mailing Address - Phone:781-762-0471
Mailing Address - Fax:781-762-8072
Practice Address - Street 1:910 WASHINGTON ST STE 200
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-6022
Practice Address - Country:US
Practice Address - Phone:781-762-0471
Practice Address - Fax:781-762-8072
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA274005208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME001173702Medicare UPIN