Healthcare Provider Details

I. General information

NPI: 1619101052
Provider Name (Legal Business Name): MIGUEL ANGEL CONCEPCION M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PARADISE RD
SWAMPSCOTT MA
01907-2948
US

IV. Provider business mailing address

250 PARADISE RD
SWAMPSCOTT MA
01907-2948
US

V. Phone/Fax

Practice location:
  • Phone: 781-596-2000
  • Fax:
Mailing address:
  • Phone: 781-596-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number113368
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number241172
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number254419
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: