Provider Demographics
NPI:1730170630
Name:FIFER, MICHAEL A (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:FIFER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-1832
Mailing Address - Fax:617-726-7437
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:GRB 8
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-1832
Practice Address - Fax:617-726-7437
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA45926207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA719437OtherTUFTS HEALTH PLAN
MAJ02987OtherBCBS MA
MA6175562Medicaid
MAJ02987OtherBCBS MA
MA719437OtherTUFTS HEALTH PLAN