Provider Demographics
NPI:1528495835
Name:MICHAEL J. OLDER, MD PC
Entity type:Organization
Organization Name:MICHAEL J. OLDER, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-772-3547
Mailing Address - Street 1:190 GROTON RD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:AYER
Mailing Address - State:MA
Mailing Address - Zip Code:01432-1124
Mailing Address - Country:US
Mailing Address - Phone:978-772-3547
Mailing Address - Fax:978-772-0558
Practice Address - Street 1:190 GROTON RD
Practice Address - Street 2:SUITE 190
Practice Address - City:AYER
Practice Address - State:MA
Practice Address - Zip Code:01432-1124
Practice Address - Country:US
Practice Address - Phone:978-772-3547
Practice Address - Fax:978-772-0558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71640174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty