Healthcare Provider Details

I. General information

NPI: 1720126410
Provider Name (Legal Business Name): MICHAEL JOSEPH HAYES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 MCGRATH HWY SUITE 204
SOMERVILLE MA
02143-4508
US

IV. Provider business mailing address

22 MCGRATH HWY SUITE 204
SOMERVILLE MA
02143-4508
US

V. Phone/Fax

Practice location:
  • Phone: 617-623-1814
  • Fax: 617-623-1817
Mailing address:
  • Phone: 617-623-1814
  • Fax: 617-623-1817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: