Healthcare Provider Details

I. General information

NPI: 1700085149
Provider Name (Legal Business Name): MICHAEL GAVIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 PILGRIM RD PALMER 217
BOSTON MA
02215-5324
US

IV. Provider business mailing address

185 PILGRIM RD PALMER 217
BOSTON MA
02215-5324
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-8800
  • Fax:
Mailing address:
  • Phone: 617-667-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number239198
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: