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General NPI Number Information
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NPI Number | 1821115544
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Entity Type | Individual
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Provider Name | MICHAEL R DRISCOLL PA
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Gender | Male
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 09/05/2007
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Provider Practice Location Address
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Address Line | 114 WHITWELL ST
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City | QUINCY
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State | MA
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Zip | 02169-1870
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Country | US
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Telephone | 617-773-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 9 APPLETON ST APT M2
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City | BOSTON
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State | MA
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Zip | 02116-5210
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Country | US
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Telephone | 404-520-4385
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 004753
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License Number State | GA
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