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NPI Code Detail

MEDICARE: DR. MICHAEL CLARENCE PAYNE M.D., M.P.H.

MEDICARE: DR. MICHAEL CLARENCE PAYNE M.D., M.P.H.
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
1207RG0100XGastroenterology Physician0420007895VT
2207RG0100XGastroenterology Physician52588MA
3207RG0100XGastroenterology PhysicianMD38144TN

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 : 1760481501
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL CLARENCE PAYNE M.D., M.P.H.
Provider Business Mailing Address
First Line : 104 SUMMER ST
Second Line :
City : MALDEN
State : MA
Zip : 02148-2520
Country : US
Telephone Number : 413-441-3718
Fax Number : 413-458-8663
Provider Business Practice Location Address
First Line : 230 HIGHLAND AVE
Second Line : SOMERVILLE HOSPITAL / THE CAMBRIDGE HEALTH ALLIANCE
City : SOMERVILLE
State : MA
Zip : 02143-1408
Country : US
Telephone Number : 617-665-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2005
Last Update Date : 02/14/2012

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