Healthcare Provider Details

I. General information

NPI: 1326038977
Provider Name (Legal Business Name): MICHAEL J YAREMCHUK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PARKMAN ST MGH WACC SUITE 435
BOSTON MA
02114-3117
US

IV. Provider business mailing address

15 PARKMAN ST MGH WACC SUITE 435
BOSTON MA
02114-3117
US

V. Phone/Fax

Practice location:
  • Phone: 978-535-6043
  • Fax: 978-535-6047
Mailing address:
  • Phone: 978-535-6043
  • Fax: 978-535-6047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number41996
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: