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A licensee who has ever held a full license in Massachusetts that was voluntarily not renewed or was revoked by operation of law must complete a lapsed application to revive their license.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

Documents

• Lapsed Application Kit  
• Lapsed License Letter 
• Lapsed License Instructions 
• Lapsed License Checklist 
• Lapsed License Application 
• Lapsed License Supplement 
• Medicare Tax Form 
• Authorization for Release 
• Malpractice History Form 
• National Practitioner Databank 
  

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This information is provided by the Board of Registration in Medicine.