Healthcare Provider Details

I. General information

NPI: 1336134857
Provider Name (Legal Business Name): MICHAEL J LANDMAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 12/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MARSTON ST SUITE 403
LAWRENCE MA
01841
US

IV. Provider business mailing address

25 MARSTON STREET SUITE
LAWRENCE MA
01841
US

V. Phone/Fax

Practice location:
  • Phone: 978-686-2400
  • Fax: 978-685-4151
Mailing address:
  • Phone: 978-686-2400
  • Fax: 978-685-4151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number159775
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3196852
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: DR. MICHAEL JOSEPH LANDMAN
Title or Position: PRESIDENT OWNER
Credential: MD
Phone: 978-686-2400