Healthcare Provider Details

I. General information

NPI: 1033122965
Provider Name (Legal Business Name): YOGMAN PEDIATRIC ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 MT AUBURN ST SUITE 202
CAMBRIDGE MA
02138
US

IV. Provider business mailing address

575 MT AUBURN ST SUITE 202
CAMBRIDGE MA
02138
US

V. Phone/Fax

Practice location:
  • Phone: 617-864-7071
  • Fax: 617-661-4682
Mailing address:
  • Phone: 617-864-7071
  • Fax: 617-661-4682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number37094
License Number StateMA

VIII. Authorized Official

Name: DR. MICHAEL W YOGMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 617-864-7071