MEDICARE: YULYA KUTSMAN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	225051	MA

General Provider Information

NPI Number	:	1588611735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YULYA KUTSMAN D.O.

Provider Business Mailing Address
First Line	:	300 BROADWAY
Second Line	:
City	:	SOMERVILLE
State	:	MA
Zip	:	02145-2935
Country	:	US
Telephone Number	:	617-284-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 BROADWAY
Second Line	:
City	:	SOMERVILLE
State	:	MA
Zip	:	02145-2935
Country	:	US
Telephone Number	:	617-284-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	11/29/2012

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