Provider Demographics
NPI:1255405973
Name:BRESNAHAN, MICHAEL HENRY (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HENRY
Last Name:BRESNAHAN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:20 PONDMEADOW DR
Mailing Address - Street 2:READING INTERNAL MEDICINE ASSOC INC
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867
Mailing Address - Country:US
Mailing Address - Phone:781-944-0040
Mailing Address - Fax:781-944-1684
Practice Address - Street 1:20 PONDMEADOW DR
Practice Address - Street 2:READING INTERNAL MEDICINE ASSOC INC
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867
Practice Address - Country:US
Practice Address - Phone:781-944-0040
Practice Address - Fax:781-944-1684
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2013-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA55004207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3009173Medicaid
MA3009173Medicaid
A58341Medicare UPIN