Provider Demographics
NPI:1386618502
Name:MASI, MICHELE L (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:L
Last Name:MASI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:115 MILL ST
Practice Address - Street 2:MCLEAN HOSPITAL
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478
Practice Address - Country:US
Practice Address - Phone:617-855-2354
Practice Address - Fax:617-855-3731
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2007-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA53825207R00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3001474Medicaid
MD053825OtherTUFTS HEALTH PLAN
MAJ04182OtherBCBS MA
MAJ04182OtherBCBS MA
B76715Medicare UPIN
MA3001474Medicaid