DR. MICHAEL C. FAHEY (NPI# 1255536082) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1255536082 |
Entity Type | Individual |
Full Name | DR. MICHAEL C. FAHEY |
Credential | M.D. |
Practice Address |
55 Lake Ave N Department of Pediatrics Worcester MA 01655-0002 |
Mailing Address |
Po Box 415348 Boston MA 02241-5348 |
Practice Telephone | 5088564154 |
Practice Fax Number | 5088568125 |
Mailing Telephone | 8002258885 |
Mailing Fax Number | 5083341977 |
Enumeration Date | 2007-06-20 |
Last Update Date | 2020-04-08 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2080P0202X |
Pediatrics Specialization: Pediatric Cardiology |
235218 | MA | Allopathic & Osteopathic Physicians |
N | 2080P0202X |
Pediatrics Specialization: Pediatric Cardiology |
236443 | NY | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
MA | 110079829A | 05 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1619076783 | Michael Dennis Fahey | Dentist | 502 3rd Street, Winnie, TX 77665 | 2006-09-22 |
1851403109 | Michael James Fahey | Surgery | 481 Plumas Blvd, Ste 103, Yuba City, CA 95991-5075 | 2006-08-31 |
1669426029 | Michael J Fahey | Nurse Anesthetist, Certified Registered | 105 N Meadows Dr, Athens, TN 37303-4172 | 2006-05-20 |
Street Address |
55 LAKE AVE N DEPARTMENT OF PEDIATRICS |
City | WORCESTER |
State | MA |
Zip Code | 01655-0002 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1477556587 | James E Liebmann | Internal Medicine | 55 Lake Ave N, Hematology/oncology, Worcester, MA 01655-0002 | 2005-05-23 |
1518568732 | Justin Bullard | Psychologist | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-11-04 |
1346849825 | Meghan Moore | Nurse Practitioner | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-10-26 |
1174122899 | Jessica Goncalves Ferreira | Nurse Practitioner | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-10-23 |
1235746686 | Desiree Mytych | Student in an Organized Health Care Education/Training Program | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-09-29 |
1659986248 | Rebecca Lynn Harris | Student in an Organized Health Care Education/Training Program | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-09-10 |
1639781487 | Gabriella Kathleen Holland | Student in an Organized Health Care Education/Training Program | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-08-21 |
1730791898 | Kerry Anne Benedict | Speech-Language Pathologist | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-08-20 |
1902418999 | Natasha R. Turner | Genetic Counselor, MS | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-08-20 |
1144830712 | Abbey Corsini | Nurse Practitioner | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-08-07 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1205489713 | Darryl Sweeper Jr. | Student in an Organized Health Care Education/Training Program | 55 Lake Avenue North, Psychiatry, Umass Memorial Medical Center, Worcester, MA 01655 | 2019-07-23 |
1225690530 | Ryan Zenevitch | Student in an Organized Health Care Education/Training Program | 55 Lake Avenue North, Family Medicine, Umass Memorial Medical Center, Worcester, MA 01655 | 2019-07-08 |
1932688454 | Victoria Sayeg | Student in an Organized Health Care Education/Training Program | 55 Lake Avenue North, Pediatrics, Worcester, MA 01655 | 2018-08-07 |
1114425675 | Judith Dio Wentzell | Social Worker | Umassmemorial Medical Center, 55 Lake Ave North, Dept of Care Coordination, Worcester, MA 01655 | 2018-01-30 |
1861927386 | Muhammad Waqas Khan | Student in an Organized Health Care Education/Training Program | University of Massachusetts 55 North Lake Ave, Neurology, Worcester, MA 01655 | 2017-04-21 |
1861806192 | Qaiser Shamshir Khan | Psychiatry & Neurology | 55 Lake Ave N # S7-831, Worcester, MA 01655 | 2014-06-14 |
1073858981 | Heidi Glover | Nurse Practitioner | 55 Lake Ave North Dept. of Pedi-adolescent, Ummc University Campus, Worcester, MA 01655 | 2012-12-04 |
1972867992 | Anna Bjornsdottir | Psychiatry & Neurology | 55 Lake Av N, Worcester, MA 01655 | 2012-06-25 |
1245567676 | Steven Edward Mckinley | Nurse Practitioner | 55 Lake Ave. North, Umass Memorial Medical Center University Campus, Worcester, MA 01655 | 2009-11-05 |
1851582951 | Robin I Davidson | Neurological Surgery | 55 Lake Ave, North, Ummhc-univ Campus, Worcester, MA 01655 | 2007-08-05 |
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Taxonomy Code | 2080P0202X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Pediatrics |
Specialization | Pediatric Cardiology |
A pediatric cardiologist provides comprehensive care to patients with cardiovascular problems. This specialist is skilled in selecting, performing and evaluating the structural and functional assessment of the heart and blood vessels, and the clinical evaluation of cardiovascular disease. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1700876380 | Child Heart Associates, LLC | Pediatrics | 33 Oak Ave, Worcester, MA 01605-2752 | 2005-10-25 |
1790861748 | Lorraine Marasco Schratz | Pediatrics | 33 Oak Ave, Worcester, MA 01605-2752 | 2006-10-31 |
1356394472 | Darshak M Sanghavi | Pediatrics | 55 Lake Ave N, Department of Pediatric Cardiology, Worcester, MA 01655-0002 | 2006-05-18 |
1518957190 | Lars Erickson | Pediatrics | 33 Oak Ave, Worcester, MA 01605-2752 | 2005-10-25 |
1871583450 | Phyllis Pollack | Pediatrics | 33 Oak Ave, Worcester, MA 01605-2752 | 2005-10-25 |
1679563258 | Maria Victoria T Tantengco | Pediatrics | 33 Oak Ave, Worcester, MA 01605-2752 | 2005-10-25 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1467933309 | Chavisa Rassameehirun | Pediatrics | 300 Longwood Ave Unit, Boston, MA 02115-5724 | 2018-08-28 |
1407300858 | Carolina Escudero | Pediatrics | 240 Heath St, Ph 16, Boston, MA 02130-1149 | 2016-08-14 |
1629358767 | The Children's Heart Center of Western Massachusetts, LLC | Pediatrics | 1754 Northampton St, Holyoke, MA 01040-1947 | 2011-08-21 |
1518087790 | Michael E. Willers | Pediatrics | 1754 Northampton Street, Holyoke, MA 01040 | 2007-03-30 |
1356495428 | Herbert E Cohn | Pediatrics | 35 Wharf Path Apt D, Marblehead, MA 01945-4653 | 2007-01-23 |
1396368460 | Lauren Sell | Pediatrics | 300 Longwood Ave, Boston, MA 02115-5724 | 2020-05-25 |
1356998645 | Ciara Mcmanus | Pediatrics | 300 Longwood Ave, Boston, MA 02115-5724 | 2019-08-21 |
1699297374 | Katie Maree Moynihan | Pediatrics | 300 Longwood Ave, Boston, MA 02115-5724 | 2017-07-13 |
1609328988 | Luciana De Franco Marcondes Gomes | Pediatrics | 300 Longwood Ave, Boston Children's Hospital Cardiology Department, Boston, MA 02115-5724 | 2016-11-02 |
1598211203 | Hanita Shai | Pediatrics | 300 Longwood Avenue, Boston, MA 02115 | 2016-09-01 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.