Provider Demographics
NPI:1770733586
Name:W MICHAEL MORRISSEY JR MD PC
Entity type:Organization
Organization Name:W MICHAEL MORRISSEY JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:W MICHEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISSEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:610-838-7638
Mailing Address - Street 1:1213 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HELLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18055-1320
Mailing Address - Country:US
Mailing Address - Phone:610-838-7638
Mailing Address - Fax:610-838-1308
Practice Address - Street 1:1213 MAIN ST
Practice Address - Street 2:
Practice Address - City:HELLERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18055-1320
Practice Address - Country:US
Practice Address - Phone:610-838-7638
Practice Address - Fax:610-838-1308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058803L208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty