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NPI Code Detail

MEDICARE: DR. MICHAEL GANNON MD

MEDICARE: DR. MICHAEL GANNON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician25MA09511000NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225441215
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL GANNON MD
Provider Business Mailing Address
First Line : PO BOX 416457
Second Line :
City : BOSTON
State : MA
Zip : 02241-2053
Country : US
Telephone Number : 844-362-1735
Fax Number : 973-290-7495
Provider Business Practice Location Address
First Line : 1973 WASHINGTON VALLEY RD
Second Line :
City : MARTINSVILLE
State : NJ
Zip : 08836-2053
Country : US
Telephone Number : 732-560-9225
Fax Number : 732-560-8095
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2014
Last Update Date : 09/07/2023

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