Provider Demographics
NPI:1194894154
Name:ERDIL, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ERDIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MOUNT ROYAL AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-1976
Mailing Address - Country:US
Mailing Address - Phone:508-251-7260
Mailing Address - Fax:508-251-7265
Practice Address - Street 1:2 MOUNT ROYAL AVE STE 410
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-1976
Practice Address - Country:US
Practice Address - Phone:508-251-7260
Practice Address - Fax:508-251-7265
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0235962083P0500X
MA452812083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTE19462Medicare UPIN