Medlock, Michael Dean

Medlock, Michael Dean is an individual health care provider with primary practice located at 47 Congress St , Salem MA 01970. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Neurological Surgery, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Neurological Surgery is his primary health care specialty. Medlock, Michael Dean can be contacted via phone (978) 744-8388.

Contact Information

Primary practice address
47 Congress St Salem MA 01970
Phone: (978) 744-8388
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurological Surgery 207T00000X 79690 Massachusetts
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 79690 Massachusetts

Profile Details

NPI number 1902887185
LBN Legal business name Medlock, Michael Dean
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 7th, 2005
Last updated Nov 18th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902887185 NPPES
Massachusetts MEDICAID 11000546A

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