Individual
MICHAEL H. FATTAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D,
Contact information
Practice address
54 BAKER AVENUE EXT, SUITE 303, CONCORD, MA 01742-2137
(978) 369-8780
(978) 369-1043
Mailing address
54 BAKER AVENUE EXT, SUITE 303, CONCORD, MA 01742-2137
(978) 369-8780
(978) 369-1043
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
246526
MA
207YS0123X
Facial Plastic Surgery Physician
Primary
246526
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110089465A
—
MA
Enumeration date
12/12/2007
Last updated
07/03/2012
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