=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013238252
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL TCHEUPDJIAN FORRESTER MD, PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2010
-----------------------------------------------------
Last Update Date | 05/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 DUKE MEDICINE CIR
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27710-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-681-1300
-----------------------------------------------------
Fax | 919-613-6984
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | MASSACHUSETTS GENERAL HOSPITAL 55 FRUIT ST.
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-726-2865
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | L-244271
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | 2020-01511
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------