Healthcare Provider Details

I. General information

NPI: 1477547941
Provider Name (Legal Business Name): MICHAEL PIACENTINI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 05/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 SCHOOL ST SUITE B
MANCHESTER MA
01944-1700
US

IV. Provider business mailing address

195 SCHOOL ST SUITE B
MANCHESTER MA
01944-1700
US

V. Phone/Fax

Practice location:
  • Phone: 978-526-4800
  • Fax: 978-526-7179
Mailing address:
  • Phone: 978-526-4800
  • Fax: 978-526-7179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number159891
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: