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General NPI Number Information
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NPI Number | 1528495835
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Entity Type | Organization
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Legal Business Name | MICHAEL J. OLDER, MD PC
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Dates
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Enumeration Date | 10/01/2013
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Last Update Date | 10/01/2013
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Provider Practice Location Address
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Address Line | 190 GROTON RD SUITE 190
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City | AYER
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State | MA
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Zip | 01432-1124
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Country | US
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Telephone | 978-772-3547
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Fax | 978-772-0558
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Provider Business Mailing Address
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Address Line | 190 GROTON RD SUITE 190
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City | AYER
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State | MA
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Zip | 01432-1124
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Country | US
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Telephone | 978-772-3547
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Fax | 978-772-0558
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL J OLDER
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Credential | M.D.
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Telephone | 978-772-3547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 71640
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License Number State | MA
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