Provider Demographics
NPI:1861427320
Name:MICHAELSON, CLIFFORD (MD)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:
Last Name:MICHAELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:75 RIVERSIDE AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4600
Mailing Address - Country:US
Mailing Address - Phone:781-756-7273
Mailing Address - Fax:781-756-7274
Practice Address - Street 1:75 RIVERSIDE AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4600
Practice Address - Country:US
Practice Address - Phone:781-756-7273
Practice Address - Fax:781-756-7274
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA60116207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3038700Medicaid
MA3038700Medicaid
MAA14198Medicare UPIN