Provider Demographics
NPI: | 1801874755 |
---|---|
Name: | FABRIZIO, MICHAEL ANTHONY JR (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | MICHAEL |
Middle Name: | ANTHONY |
Last Name: | FABRIZIO |
Suffix: | JR |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 387 COLUMBUS AVENUE EXT |
Mailing Address - Street 2: | |
Mailing Address - City: | PITTSFIELD |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 01201-4909 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 413-443-9629 |
Mailing Address - Fax: | 413-445-6523 |
Practice Address - Street 1: | 387 COLUMBUS AVENUE EXT |
Practice Address - Street 2: | |
Practice Address - City: | PITTSFIELD |
Practice Address - State: | MA |
Practice Address - Zip Code: | 01201-4909 |
Practice Address - Country: | US |
Practice Address - Phone: | 413-443-9629 |
Practice Address - Fax: | 413-445-6523 |
Is Sole Proprietor?: | Not Answered |
Enumeration Date: | 2006-01-01 |
Last Update Date: | 2025-09-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MA | 43684 | 208000000X, 2080P0006X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2080P0006X | Allopathic & Osteopathic Physicians | Pediatrics | Developmental - Behavioral Pediatrics |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MA | 9763805 | Medicaid | |
MA | 9763805 | Medicaid |