Healthcare Provider Details

I. General information

NPI: 1588763098
Provider Name (Legal Business Name): MICHAEL S. ROSENBLATT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 11/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAHEY CLINIC 41 MALL ROAD
BURLINGTON MA
01805-0001
US

IV. Provider business mailing address

LAHEY CLINIC 41 MALL ROAD
BURLINGTON MA
01805-0001
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-8000
  • Fax: 781-744-5215
Mailing address:
  • Phone: 781-744-5100
  • Fax: 781-744-5215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number58162
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number58162
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: