Provider Demographics
NPI:1538156880
Name:HAMROCK, MICHAEL G (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:HAMROCK
Suffix:
Gender:
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:BMCHS PROVIDER ENROLLMENT
Mailing Address - Street 2:960 MASSACHUSETTS AVE FLR 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2020 CENTRE ST
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-3316
Practice Address - Country:US
Practice Address - Phone:617-327-0700
Practice Address - Fax:617-327-6558
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA153780207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3183840Medicaid
MA3183840Medicaid
MAA28585Medicare ID - Type Unspecified