Healthcare Provider Details

I. General information

NPI: 1922503945
Provider Name (Legal Business Name): MICHAEL FLYNN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TECHNOLOGY PARK DR
BOURNE MA
02532-8341
US

IV. Provider business mailing address

2 TECHNOLOGY PARK DR
BOURNE MA
02532-8341
US

V. Phone/Fax

Practice location:
  • Phone: 508-743-9543
  • Fax: 508-743-8335
Mailing address:
  • Phone: 508-743-9543
  • Fax: 508-743-8335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number286662
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: