Basic Information
Provider Information
NPI: 1134532468
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HONIGBERG
FirstName: MICHAEL
MiddleName: CROSSMAN
NamePrefix: DR.
NameSuffix:  
Credential: M.D., M.P.P.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 75 FRANCIS ST
Address2:  
City: BOSTON
State: MA
PostalCode: 021156110
CountryCode: US
TelephoneNumber: 6177325500
FaxNumber:  
Practice Location
Address1: 55 FRUIT STREET
Address2: YAWKEY 5B
City: BOSTON
State: MA
PostalCode: 02114
CountryCode: US
TelephoneNumber: 6177262677
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/04/2014
LastUpdateDate: 06/12/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/12/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000X268978MAY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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