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General NPI Number Information
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NPI Number | 1083633580
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Entity Type | Individual
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Provider Name | MICHAEL J.F. IANNESSA M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 05/31/2012
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Provider Practice Location Address
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Address Line | 1233 STATE RD
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City | PLYMOUTH
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State | MA
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Zip | 02360-5133
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Country | US
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Telephone | 508-224-7701
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Fax |
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Provider Business Mailing Address
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Address Line | 40 CHESTNUT ST APT. #2
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City | CHARLESTOWN
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State | MA
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Zip | 02129-3436
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Country | US
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Telephone | 781-254-1148
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 52862
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 52862
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License Number State | MA
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