Healthcare Provider Details

I. General information

NPI: 1679835011
Provider Name (Legal Business Name): MICHAEL HONG-TAK MA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKLINE PL STE 327
BROOKLINE MA
02445-7238
US

IV. Provider business mailing address

1 BROOKLINE PL STE 327
BROOKLINE MA
02445-7238
US

V. Phone/Fax

Practice location:
  • Phone: 617-735-8585
  • Fax:
Mailing address:
  • Phone: 617-735-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number261756
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: