=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669453981
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE M NORTH MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2005
-----------------------------------------------------
Last Update Date | 06/25/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 51 PERFORMANCE DR
-----------------------------------------------------
City | WEYMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02189-3104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-682-8000
-----------------------------------------------------
Fax | 781-335-1412
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 75 WASHINGTON ST
-----------------------------------------------------
City | NORWELL
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02061-1795
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-792-4191
-----------------------------------------------------
Fax | 781-878-6750
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 216984
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------