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Board of Medicine Address
  Commonwealth of Massachusetts
  Board of Registration in Medicine
  560 Harrison Avenue, Suite G-4
  Boston, MA 02118
  (617) 654-9800
  (617) 423-5604 TTY

  Hours M-F; 8:45 a.m. to 5:00 p.m.

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Home > Physician Information > Lapsed License

Downloadable Application
Kits for
Lapsed License

A licensee who has ever held a full license in Massachusetts that was voluntarily not renewed or was revoked by operation of law must complete a lapsed application to revive their license.

Please read the instructions carefully before completing your application.

Remember: if your license lapses, YOU MAY NOT PRACTICE MEDICINE IN MASSACHUSETTS IN ANY FASHION OR CAPACITY UNTIL YOUR LICENSE IS REVIVED BY THE BOARD.

Lapsed License Documents

Lapsed Application Kit Adobe Acrobat Document
Lapsed License Letter Adobe Acrobat Document
Lapsed License Instructions Adobe Acrobat Document
Lapsed License Checklist Adobe Acrobat Document
Lapsed License Application Adobe Acrobat Document
Lapsed License Supplement Adobe Acrobat Document
Medicare Tax Form Adobe Acrobat Document
Authorization for Release Adobe Acrobat Document
Malpractice History Form Adobe Acrobat Document
AMA Profile Request Form Adobe Acrobat Document
NPDB Profile Instructions Adobe Acrobat Document
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