Healthcare Provider Details

I. General information

NPI: 1073576575
Provider Name (Legal Business Name): MICHAEL L GOLDABER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 WALNUT ST STE 520
WELLESLEY MA
02481
US

IV. Provider business mailing address

27 DONNELLY DR
DOVER MA
02030
US

V. Phone/Fax

Practice location:
  • Phone: 781-237-3500
  • Fax: 781-237-7867
Mailing address:
  • Phone: 508-785-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number58820
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: