Healthcare Provider Details

I. General information

NPI: 1801890835
Provider Name (Legal Business Name): MICHAEL WILLIAM YOGMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 MOUNT AUBURN ST STE 202
CAMBRIDGE MA
02138-4627
US

IV. Provider business mailing address

575 MOUNT AUBURN ST STE 202
CAMBRIDGE MA
02138-4627
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
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number37094
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: