Healthcare Provider Details

I. General information

NPI: 1902865363
Provider Name (Legal Business Name): HENRY MARTIN YAGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 WASHINGTON ST
NEWTON MA
02462-1607
US

IV. Provider business mailing address

2014 WASHINGTON ST
NEWTON MA
02462-1607
US

V. Phone/Fax

Practice location:
  • Phone: 617-244-6940
  • Fax: 617-243-6701
Mailing address:
  • Phone: 617-244-6940
  • Fax: 617-243-6701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number33779
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: