Healthcare Provider Details

I. General information

NPI: 1639770829
Provider Name (Legal Business Name): MICHELLE MORRIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MGH BACK BAY HEALTHCARE CENTER 388 COMMONWEALTH AVE
BOSTON MA
02215-2800
US

IV. Provider business mailing address

MGH BACK BAY HEALTHCARE CENTER 388 COMMONWEALTH AVE
BOSTON MA
02215-2800
US

V. Phone/Fax

Practice location:
  • Phone: 617-267-7171
  • Fax:
Mailing address:
  • Phone: 617-267-7171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1017353
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: