Provider Demographics
NPI:1487611554
Name:MCGEACHIE, MICHELLE (NP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MCGEACHIE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:PERRELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:295 SALEM ST UNIT 48
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-2067
Mailing Address - Country:US
Mailing Address - Phone:978-771-0590
Mailing Address - Fax:
Practice Address - Street 1:600 W CUMMINGS PARK
Practice Address - Street 2:SUITE 1900 C/O LEO M CASS M.D.
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6369
Practice Address - Country:US
Practice Address - Phone:978-771-0590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213922363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP4298OtherMEDICARE
MA0399884Medicaid
MA0399884Medicaid
MANP4298Medicare ID - Type Unspecified