Provider Demographics
NPI:1295771830
Name:URBAN, MICHELLE A (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:A
Last Name:URBAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:454 OLD STREET RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-1200
Mailing Address - Country:US
Mailing Address - Phone:603-924-4664
Mailing Address - Fax:603-924-8653
Practice Address - Street 1:454 OLD STREET RD
Practice Address - Street 2:SUITE 207
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1200
Practice Address - Country:US
Practice Address - Phone:603-924-4664
Practice Address - Fax:603-924-8653
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2012-04-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH10378207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30011522Medicaid
NH30011522Medicaid
A16397Medicare UPIN