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Provider Information for 1669650685

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Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

MICHAEL DOCKTOR MD

Gender: MALE

Individual NPI: 1669650685

Calendar   Last Updated:  2015-12-09
  Certification Date: 

Details

Name Value
NPI 1669650685
Enumeration Date 2008-01-31
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 30 ABBOTT ST
NEEDHAM, MA 02492-1830
United States

Phone: | Fax:
View Map External Link
Primary Practice Address 300 LONGWOOD AVE HUNNEWELL GROUND
BOSTON, MA 02115-5724
United States

Phone: 617-355-6058 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 2080P0206X - Pediatrics Pediatric Gastroenterology MA 235349
No 208000000X - Pediatrics MA 235349