1588779607 NPI number — DR. MICHAEL K GAVIGAN DPM

Table of content: DR. MICHAEL K GAVIGAN DPM (NPI 1588779607)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588779607 NPI number — DR. MICHAEL K GAVIGAN DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAVIGAN
Provider First Name:
MICHAEL
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GAVIGAN
Provider Other First Name:
MICHAEL
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1588779607
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3227
Provider Second Line Business Mailing Address:
SUITE #17
Provider Business Mailing Address City Name:
POCASSET
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02559-3227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-563-7133
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 BARLOWS LANDING RD
Provider Second Line Business Practice Location Address:
SUITE #17
Provider Business Practice Location Address City Name:
POCASSET
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02559-1980
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-563-7133
Provider Business Practice Location Address Fax Number:
508-563-6771
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  1770 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1588779607 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 27-07976 . This is a "EVERCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 33081 . This is a "HPHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 710223 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0361704 . This is a "MEDICAID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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