Healthcare Provider Details

I. General information

NPI: 1023037611
Provider Name (Legal Business Name): MICHELLE Z GURVITZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE BOSTON CHILDREN'S HOSPITAL / CARDIOLOGY
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVE BOSTON CHILDREN'S HOSPITAL / CARDIOLOGY
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6508
  • Fax: 617-739-8632
Mailing address:
  • Phone: 617-355-6508
  • Fax: 617-739-8632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA61361
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00045538
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMD00045538
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number245758
License Number StateMA
# 5
Primary TaxonomyY
Taxonomy Code207RA0002X
TaxonomyAdult Congenital Heart Disease Physician
License Number245758
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: