Healthcare Provider Details

I. General information

NPI: 1548256308
Provider Name (Legal Business Name): MICHAEL ROCKLAND VERRILLI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 CENTER ST SUITE 418
NORTHAMPTON MA
01060-3031
US

IV. Provider business mailing address

16 CENTER ST SUITE 418
NORTHAMPTON MA
01060-3031
US

V. Phone/Fax

Practice location:
  • Phone: 413-584-5921
  • Fax:
Mailing address:
  • Phone: 413-584-5921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number60481
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number60481
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: