Healthcare Provider Details

I. General information

NPI: 1043887300
Provider Name (Legal Business Name): MICHAEL OSULLIVAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 MASONIC ST
NORTHAMPTON MA
01060-3008
US

IV. Provider business mailing address

79 MASONIC ST
NORTHAMPTON MA
01060-3008
US

V. Phone/Fax

Practice location:
  • Phone: 413-483-3282
  • Fax: 413-679-5822
Mailing address:
  • Phone: 413-483-3282
  • Fax: 413-679-5822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number288395
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: