Healthcare Provider Details

I. General information

NPI: 1457334963
Provider Name (Legal Business Name): EDWIN CHARLES HUANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 MOUNT AUBURN ST
CAMBRIDGE MA
02138
US

IV. Provider business mailing address

330 MOUNT AUBURN ST
CAMBRIDGE MA
02138-5502
US

V. Phone/Fax

Practice location:
  • Phone: 617-499-5151
  • Fax: 617-499-5179
Mailing address:
  • Phone: 617-499-5151
  • Fax: 617-499-5179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number235042
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: